Individual
PETER J POLVERINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, DMSC
Contact information
Practice address
1011 N UNIVERSITY AVE, ANN ARBOR, MI 48109-1078
(734) 763-6933
(734) 763-5142
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453
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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