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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