Provider Demographics
NPI:1588715767
Name:SHAW, ALEX MING (DDS)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:MING
Last Name:SHAW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1669 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3718
Mailing Address - Country:US
Mailing Address - Phone:707-676-7900
Mailing Address - Fax:707-427-5508
Practice Address - Street 1:2201 BOYNTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4319
Practice Address - Country:US
Practice Address - Phone:707-422-2236
Practice Address - Fax:707-427-5508
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA547861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice