Organization
SHORES DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL SHAW DDS, MS (MANAGER)
(248) 931-1151
Entity
Organization
Contact information
Practice address
28503 LITTLE MACK AVE, SAINT CLAIR SHORES, MI 48081-1119
(248) 771-1990
Mailing address
350 PINE RIDGE DR, BLOOMFIELD HILLS, MI 48304-2139
(248) 931-1151
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13819
MI
Other
Enumeration date
02/27/2017
Last updated
02/27/2017
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