# JACK C SHADER DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912000977
- **Authorized official:** DR. JACK C SHADER DDS (PRESIDENT)
- **Authorized official phone:** (248) 625-9444

## Contact information

- **Practice address:** 6300 SASHABAW RD, STE A, CLARKSTON, MI 48436
- **Practice address phone:** (248) 625-9444
- **Practice address fax:** (248) 625-4813
- **Mailing address:** 6300 SASHABAW RD, STE A, CLARKSTON, MI 48436
- **Mailing address phone:** (248) 625-9444
- **Mailing address fax:** (248) 625-4813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 11126 | MI | Yes |

## Other

- **Enumeration date:** 09/06/2006
- **Last updated:** 08/22/2020