Provider Demographics
NPI:1508442195
Name:MICHIGAN RESTORATIVE INSTITUTE, PLLC
Entity Type:Organization
Organization Name:MICHIGAN RESTORATIVE INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-217-6442
Mailing Address - Street 1:7676 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1500
Mailing Address - Country:US
Mailing Address - Phone:734-354-9500
Mailing Address - Fax:734-354-9502
Practice Address - Street 1:7676 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1500
Practice Address - Country:US
Practice Address - Phone:734-354-9500
Practice Address - Fax:734-354-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty