Provider Demographics
NPI:1417072612
Name:REGENTS OF THE UNIV OF MI COMMUNITY DENTAL CENTER
Entity Type:Organization
Organization Name:REGENTS OF THE UNIV OF MI COMMUNITY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-998-9640
Mailing Address - Street 1:406 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-3308
Mailing Address - Country:US
Mailing Address - Phone:734-998-9640
Mailing Address - Fax:734-998-9647
Practice Address - Street 1:406 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-3308
Practice Address - Country:US
Practice Address - Phone:734-998-9640
Practice Address - Fax:734-998-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Not Answered126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI88067OtherDELTA DENTAL OF MI DENTIS
MI88129OtherDELTA DENTAL OF MI PERIO
MID800484OtherBCBS OF MI DENTAL