Provider Demographics
NPI:1194962753
Name:MICHIGAN IMPLANTS & PERIODONTICS INSTITUTE, P.L.C.
Entity type:Organization
Organization Name:MICHIGAN IMPLANTS & PERIODONTICS INSTITUTE, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MISCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:734-975-1743
Mailing Address - Street 1:2755 CARPENTER RD
Mailing Address - Street 2:SUITE 2NE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1186
Mailing Address - Country:US
Mailing Address - Phone:734-975-1743
Mailing Address - Fax:
Practice Address - Street 1:2755 CARPENTER RD
Practice Address - Street 2:SUITE 2NE
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1186
Practice Address - Country:US
Practice Address - Phone:734-975-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010190931223P0300X
MI29010189461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty