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General NPI Number Information
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NPI Number | 1457641052
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Entity Type | Organization
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Legal Business Name | RESTORATION FAMILY DENTAL,PLLC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 4750 OKEMOS RD
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City | OKEMOS
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State | MI
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Zip | 48864-1637
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Country | US
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Telephone | 517-574-5577
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Fax | 517-574-5523
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Provider Business Mailing Address
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Address Line | 4750 OKEMOS RD
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City | OKEMOS
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State | MI
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Zip | 48864-1637
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Country | US
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Telephone | 517-574-5577
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Fax | 517-574-5523
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. STEPHEN A PHILLIPS
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Credential | DDS
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Telephone | 517-574-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901017323
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License Number State | MI
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