Provider Demographics
NPI:1124143300
Name:REGENTS OF THE UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY
Entity type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN FOR PATIENT SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLIAH
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:888-707-2500
Mailing Address - Street 1:1011 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1078
Mailing Address - Country:US
Mailing Address - Phone:888-707-2500
Mailing Address - Fax:734-647-4024
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:888-707-2500
Practice Address - Fax:734-647-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI970H11102OtherBCBS OF MI MED SURGICAL
MI190H11093OtherBCBS OF MI MED SURGICAL
MI026194OtherMIDWEST HEALTH
OH2667823Medicaid
MI4615102Medicaid
MID800336OtherBCBS OF MI DENTAL
MIQMXPR0028409OtherMOLINA HEALTHCARE OF MI
MI0985982OtherHEALTH PLUS OF MI
MI43-29007OtherPHP OF MI
MI4613082Medicaid
MI88006OtherDELTA OF MI GENL
MIDD81017OtherM-CARE
MI43-29007OtherPHP OF MI
MI4613082Medicaid