Healthcare Provider Details

I. General information

NPI: 1639369358
Provider Name (Legal Business Name): CARDON & SORROW ORAL AND MAXILLOFACIAL SURGERY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 ROBINSON RD
JACKSON MI
49203-1155
US

IV. Provider business mailing address

683 ROBINSON RD
JACKSON MI
49203-1155
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-0417
  • Fax: 517-787-5536
Mailing address:
  • Phone: 517-787-0417
  • Fax: 517-787-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberOC016653
License Number StateMI

VIII. Authorized Official

Name: DR. ORSON P CARDON
Title or Position: OWNER, PRESIDENT
Credential: D.M.D.
Phone: 517-787-0417