Healthcare Provider Details

I. General information

NPI: 1962013128
Provider Name (Legal Business Name): MIBRACES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W MICHIGAN AVE
SALINE MI
48176-1327
US

IV. Provider business mailing address

5766 GEDDES RD
ANN ARBOR MI
48105-9331
US

V. Phone/Fax

Practice location:
  • Phone: 734-470-4068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT SCHUSTER
Title or Position: PRESIDENT
Credential:
Phone: 248-790-5650