Organization
OFFICE 3 PLLC
Active
Parent organization
DENTAL SPECIALISTS PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL SPECIALISTS PLLC
Authorized official
DR. RANDALL SHAW (MANAGER)
(248) 931-1151
Entity
Organization
Contact information
Practice address
31590 SCHOOLCRAFT RD, LIVONIA, MI 48150
(248) 931-1151
Mailing address
350 PINE RIDGE DR, BLOOMFIELD HILLS, MI 48304-2139
(248) 931-1151
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901013819
MI
1223G0001X
General Practice Dentistry
2901010706
MI
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174669584
DENTIST
—
01
—
1770628687
NPPES
MI
Enumeration date
02/06/2018
Last updated
11/24/2020
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