Provider Demographics
NPI:1811006919
Name:SHAW, FREDRICK ALEXANDER III (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:ALEXANDER
Last Name:SHAW
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 W 38TH ST
Mailing Address - Street 2:STE #34
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6321
Mailing Address - Country:US
Mailing Address - Phone:512-451-7491
Mailing Address - Fax:512-451-5388
Practice Address - Street 1:1500 W 38TH ST
Practice Address - Street 2:STE #34
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6321
Practice Address - Country:US
Practice Address - Phone:512-451-7491
Practice Address - Fax:512-451-5388
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178671223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics