Healthcare Provider Details

I. General information

NPI: 1417072612
Provider Name (Legal Business Name): REGENTS OF THE UNIV OF MI COMMUNITY DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N ASHLEY ST
ANN ARBOR MI
48109-3308
US

IV. Provider business mailing address

406 N ASHLEY ST
ANN ARBOR MI
48109-3308
US

V. Phone/Fax

Practice location:
  • Phone: 734-998-9640
  • Fax: 734-998-9647
Mailing address:
  • Phone: 734-998-9640
  • Fax: 734-998-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DORIS J ALLEN
Title or Position: DIRECTOR
Credential: DDS
Phone: 734-998-9640