Individual
JACK CARL SHADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6300 SASHABAW RD, CLARKSTON, MI 48346-2269
(248) 625-9444
(248) 625-4813
Mailing address
6300 SASHABAW RD, CLARKSTON, MI 48346
(248) 625-9444
(248) 625-4813
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901011126
MI
Other
Enumeration date
10/23/2006
Last updated
07/08/2007
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