Provider Demographics
NPI:1285889709
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:KITRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-647-8091
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:734-764-1543
Mailing Address - Fax:734-764-2469
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:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184651223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty