Organization
OFFICE 6 PLLC
Active
Other names
Wellspring Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL SHAW DDS, MS. (OWNER)
(248) 931-1151
Entity
Organization
Contact information
Practice address
20136 MACK AVE, GROSSE POINTE WOODS, MI 48236-1820
(313) 886-9355
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
Enumeration date
12/08/2020
Last updated
12/08/2020
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