# REGENTS OF THE UNIVERSITY OF MICHIGAN DENTAL FACULTY ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386899805
- **Authorized official:** PETER J POLVERINI DDS (DEAN, UNIV OF MI SCHOOL OF DENTISTR)
- **Authorized official phone:** (734) 764-9185

## Contact information

- **Practice address:** 1011 N UNIVERSITY AVE, ANN ARBOR, MI 48109-1078
- **Practice address phone:** (734) 764-3155
- **Practice address fax:** (734) 615-4784
- **Mailing address:** 1011 N UNIVERSITY AVE, ANN ARBOR, MI 48109-1078
- **Mailing address phone:** (734) 764-3155
- **Mailing address fax:** (734) 615-4784

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 2901016040 | MI | — |
| 1223G0001X | General Practice Dentistry | 2901016040 | MI | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | 2901016040 | MI | — |
| 1223P0221X | Pediatric Dentistry | 2901016040 | MI | — |
| 1223P0300X | Periodontics | 2901016040 | MI | — |
| 1223P0700X | Prosthodontics | 2901016040 | MI | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2901016040 | MI | — |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | 2901016040 | MI | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | 2901016040 | MI | — |

## Other

- **Enumeration date:** 11/25/2008
- **Last updated:** 11/25/2008