| Office 4 Pllc | |
|
2555 Spring Arbor Rd Jackson MI 49203-3601 | |
| (517) 787-8321 | |
| Not Available |
| Full Name | Office 4 Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2555 Spring Arbor Rd, Jackson, Michigan |
| Authorized Official Name and Position | Randall Loren Shaw (OWNER) |
| Authorized Official Contact | 2489311151 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Office 4 Pllc 350 Pine Ridge Dr Bloomfield Hills MI 48304-2139 Ph: (248) 931-1151 | Office 4 Pllc 2555 Spring Arbor Rd Jackson MI 49203-3601 Ph: (517) 787-8321 |
| NPI Number | 1578045548 |
|---|---|
| Provider Enumeration Date | 09/05/2018 |
| Last Update Date | 11/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578045548 | NPI | - | NPPES |
| 1770597890 | Other | MI | DENTAL |
| 1316232655 | Other | MI | DENTIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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