Jack C Shader DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11126 Issued in MI

Legal business name

JACK C SHADER DDS PC

Practice address

6300 Sashabaw Rd
Ste a
Clarkston, MI 48436

Phone

(248) 625-9444

Fax

(248) 625-4813

NPI assigned

Sep 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jack C Shader, DDS

Title

President

Phone

(248) 625-9444

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aaron Edward McLemore, DMD

  • General Practice Dentistry
  • Clarkston, MI
  • NPI 1487888228
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912000977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 SASHABAW RD",
            "address_2": "STE A",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "48436",
            "telephone_number": "248-625-9444",
            "fax_number": "248-625-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 SASHABAW RD",
            "address_2": "STE A",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "48436",
            "telephone_number": "248-625-9444",
            "fax_number": "248-625-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK C SHADER DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHADER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-625-9444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "11126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Istifan
• It's a New Day Counseling, LLC
• Giovanna Ivezaj, BSN, RN
• J Scott Allen Jr PHD LLC
• Valerie Jabero, PA-C
• Katelinn Jackard, M.S., BCBA, LBA
• Charlotte Marie Jackson-Melvin, R.N. M.S.N.
• Amelia C Jackson, LMSW
• Hershel Jackson Jr., MA, LPC
• Ni-Keya Jackson

• General Practice Dentistry in Clarkston, MI
• Providers in Clarkston, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.