# REGENTS OF THE UNIVERSITY OF MICHIGAN DENTAL FACULTY ASSOCIATES

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

## Provider details

- **NPI number:** 1932279882
- **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) 764-9185
- **Mailing address fax:** (734) 647-8090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | 2901016040 | MI | Yes |
| 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

- **Enumeration date:** 11/08/2006
- **Last updated:** 08/20/2008

## 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 |