| Office 5 Pllc | |
|
201 S Lafayette St South Lyon MI 48178-1405 | |
| (248) 437-4119 | |
| Not Available |
| Full Name | Office 5 Pllc |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 201 S Lafayette St, South Lyon, 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 5 Pllc 350 Pine Ridge Dr Bloomfield Hills MI 48304-2139 Ph: (248) 931-1151 | Office 5 Pllc 201 S Lafayette St South Lyon MI 48178-1405 Ph: (248) 437-4119 |
| NPI Number | 1407450877 |
|---|---|
| Provider Enumeration Date | 11/25/2020 |
| Last Update Date | 11/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407450877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Primary |
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