Provider Demographics
NPI:1750386280
Name:SHAW, WILLIAM E (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:SHAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-5441
Mailing Address - Country:US
Mailing Address - Phone:920-922-6880
Mailing Address - Fax:920-922-6802
Practice Address - Street 1:531 FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5441
Practice Address - Country:US
Practice Address - Phone:920-922-6880
Practice Address - Fax:920-922-6802
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50020451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice