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Individual
PETER J POLVERINI
Active
Individual
PETER J POLVERINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, DMSC
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901016040
MI
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
2901016040
MI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
2901016040
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
195816845
BCBS OF MI MED SURGICAL
MI
05
—
2667583
—
OH
05
—
4070694
—
MI
05
—
4504373
—
MI
05
—
4874042
—
MI
01
—
D160400
BCBS OF MI DENTAL
MI
Enumeration date
03/14/2007
Last updated
01/29/2020
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