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Organization
REGENTS OF THE UNIVERSITY OF MICHIGAN DENTAL FACULTY ASSOCIATES
Active
Organization
REGENTS OF THE UNIVERSITY OF MICHIGAN DENTAL FACULTY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER J POLVERINI DDS (DEAN, UNIV OF MI SCHOOL OF DENTISTR)
(734) 764-9185
Entity
Organization
Contact information
Practice address
1011 N UNIVERSITY AVE, ANN ARBOR, MI 48109-1078
(734) 764-3155
(734) 615-4784
Mailing address
1011 N UNIVERSITY AVE, ANN ARBOR, MI 48109-1078
(734) 764-9185
(734) 647-8090
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
2901016040
MI
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0008X
Oral and Maxillofacial Radiology Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025748
MIDWEST HEALTH
MI
01
—
1006664
MCLAREN ADVANTAGE
MI
01
—
1476671
UNITED CONCORDIA
MI
01
—
190H110980
BCBS OF MI MEDSURG #
MI
05
—
2667609
—
OH
01
—
43-20001
PHP OF MI
MI
01
—
43-28004
PHP OF MI
MI
05
—
4504346
—
MI
05
—
4504373
—
MI
01
—
88054
DELTA DENTAL OF MI - GENL
MI
01
—
970H110770
BCBS OF MI ORALSURGERY
MI
01
—
D800363
BCBS OF MI GENLDENTIST
MI
01
—
QMXPR0014549
MOLINA HEALTHCARE
MI
01
—
XX19411
HEALTH PLUS OF MI
MI
Enumeration date
11/08/2006
Last updated
08/20/2008
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