Provider Demographics
NPI:1710074729
Name:DONALD A. RESTAURI JR DDS PC
Entity Type:Organization
Organization Name:DONALD A. RESTAURI JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RESTAURI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-231-2424
Mailing Address - Street 1:5589 E MI 36
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9260
Mailing Address - Country:US
Mailing Address - Phone:810-231-2424
Mailing Address - Fax:810-231-2807
Practice Address - Street 1:5589 E MI 36
Practice Address - Street 2:SUITE 11
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-9260
Practice Address - Country:US
Practice Address - Phone:810-231-2424
Practice Address - Fax:810-231-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013193261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental