Individual
RANDALL LOREN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.S.
Contact information
Practice address
18860 W 10 MILE RD, SOUTHFIELD, MI 48075-2666
(248) 565-3331
Mailing address
350 PINE RIDGE DR, BLOOMFIELD HILLS, MI 48304-2139
(248) 931-1151
(248) 594-2221
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
13819
MI
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
29010.013819
MI
Other
Enumeration date
08/19/2008
Last updated
11/24/2020
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