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Organization

OFFICE 5 PLLC

Active
Other names
South Lyon Dental
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RANDALL LOREN SHAW DDS, MS (OWNER)
(248) 931-1151
Entity
Organization

Contact information

Practice address
201 S LAFAYETTE ST, SOUTH LYON, MI 48178-1405
(248) 437-4119
Mailing address
350 PINE RIDGE DR, BLOOMFIELD HILLS, MI 48304-2139
(248) 931-1151
(248) 594-2221

Taxonomy

Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary

Other

Enumeration date
11/25/2020
Last updated
11/25/2020
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