Healthcare Provider Details

I. General information

NPI: 1336654805
Provider Name (Legal Business Name): OFFICE 2 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3526 W SAGINAW ST
LANSING MI
48917
US

IV. Provider business mailing address

3526 W SAGINAW ST
LANSING MI
48917-2292
US

V. Phone/Fax

Practice location:
  • Phone: 517-321-2539
  • Fax:
Mailing address:
  • Phone: 517-321-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDALL LOREN SHAW
Title or Position: OWNER
Credential: DDS
Phone: 248-931-1151