1932279882 NPI number — REGENTS OF THE UNIVERSITY OF MICHIGAN DENTAL FACULTY ASSOCIATES

Table of content: (NPI 1932279882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932279882 NPI number — REGENTS OF THE UNIVERSITY OF MICHIGAN DENTAL FACULTY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS OF THE UNIVERSITY OF MICHIGAN DENTAL FACULTY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932279882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 N UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48109-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-764-9185
Provider Business Mailing Address Fax Number:
734-647-8090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 N UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48109-1078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-764-3155
Provider Business Practice Location Address Fax Number:
734-615-4784
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLVERINI
Authorized Official First Name:
PETER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DEAN, UNIV OF MI SCHOOL OF DENTISTR
Authorized Official Telephone Number:
734-764-9185

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 2901016040 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0008X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 970H110770 . This is a "BCBS OF MI ORALSURGERY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: XX19411 . This is a "HEALTH PLUS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1006664 . This is a "MCLAREN ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2667609 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43-20001 . This is a "PHP OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 43-28004 . This is a "PHP OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4504346 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190H110980 . This is a "BCBS OF MI MEDSURG #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 025748 . This is a "MIDWEST HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1476671 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4504373 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88054 . This is a "DELTA DENTAL OF MI - GENL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: D800363 . This is a "BCBS OF MI GENLDENTIST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: QMXPR0014549 . This is a "MOLINA HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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