Organization
OFFICE 4 PLLC
Active
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
2555 SPRING ARBOR RD, JACKSON, MI 49203-3601
(517) 787-8321
Mailing address
350 PINE RIDGE DR, BLOOMFIELD HILLS, MI 48304-2139
(248) 931-1151
(248) 594-2221
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316232655
DENTIST
MI
01
—
1770597890
DENTAL
MI
Enumeration date
09/05/2018
Last updated
11/24/2020
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