Organization
DENTAL SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL SHAW (MANAGER)
(248) 931-1151
Entity
Organization
Contact information
Practice address
3526 W SAGINAW ST, LANSING, MI 48917
(517) 321-2539
Mailing address
350 PINE RIDGE DR, BLOOMFIELD HILLS, MI 48304-2139
(248) 931-1151
(248) 594-2221
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/24/2017
Last updated
09/05/2018
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