Provider Demographics
NPI:1568819209
Name:MICHAEL SHOFF P.L.L.C.
Entity Type:Organization
Organization Name:MICHAEL SHOFF P.L.L.C.
Other - Org Name:SHOFF ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:360-676-1401
Mailing Address - Street 1:3628 MERIDIAN ST
Mailing Address - Street 2:STE 2B
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1735
Mailing Address - Country:US
Mailing Address - Phone:360-676-1401
Mailing Address - Fax:
Practice Address - Street 1:3628 MERIDIAN ST
Practice Address - Street 2:STE 2B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1735
Practice Address - Country:US
Practice Address - Phone:360-676-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 602899831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty