Provider Demographics
NPI:1083739262
Name:REGENTS OF THE UNIVERSITY OF MICHIGAN ORAL PATHOLOGY
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF MICHIGAN ORAL PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:D'SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PHS
Authorized Official - Phone:734-764-1543
Mailing Address - Street 1:4251 PLYMOUTH RD
Mailing Address - Street 2:BUILDING 3 SUITE 2400
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2789
Mailing Address - Country:US
Mailing Address - Phone:734-647-8091
Mailing Address - Fax:734-647-8090
Practice Address - Street 1:1011 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1078
Practice Address - Country:US
Practice Address - Phone:734-764-1543
Practice Address - Fax:734-764-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI027740OtherMIDWEST HEALTH
MI190H110650OtherBCBS OF MI MED SURGICAL
MIDD81014OtherM-CARE
MIXX20091OtherHEALTH PLUS OF MI
MIQMXPR0013422OtherMOLINA HEALTHCARE OF MI
MI027740OtherMIDWEST HEALTH
MIDD81014OtherM-CARE