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General NPI Number Information
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NPI Number | 1578045548
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Entity Type | Organization
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Legal Business Name | OFFICE 4 PLLC
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 2555 SPRING ARBOR RD
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City | JACKSON
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State | MI
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Zip | 49203-3601
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Country | US
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Telephone | 517-787-8321
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Fax |
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Provider Business Mailing Address
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Address Line | 350 PINE RIDGE DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-2139
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Country | US
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Telephone | 248-931-1151
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Fax | 248-594-2221
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDALL LOREN SHAW
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Credential | DDS, MS.
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Telephone | 248-931-1151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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