Provider Demographics
NPI:1356811756
Name:MICHIGAN RESTORATIVE INSTITUTE, PLLC
Entity type:Organization
Organization Name:MICHIGAN RESTORATIVE INSTITUTE, PLLC
Other - Org Name:<UNAVAIL>
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 1:4036 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3800
Mailing Address - Country:US
Mailing Address - Phone:810-385-9766
Mailing Address - Fax:
Practice Address - Street 1:4036 24TH AVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3800
Practice Address - Country:US
Practice Address - Phone:810-385-9766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901022154OtherDENTAL LICENSE
MI2901022068OtherDENTAL LICENSE
MI2901022057OtherDENTAL LICENSE
MI2901021060OtherDENTAL LICENSE
MI2901022368OtherDENTAL LICENSE