Healthcare Provider Details

I. General information

NPI: 1851496830
Provider Name (Legal Business Name): ORSON P CARDON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 ROBINSON RD
JACKSON MI
49203-1155
US

IV. Provider business mailing address

2550 MEADOWBROOK LN
JACKSON MI
49201-7702
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-0417
  • Fax: 517-787-5536
Mailing address:
  • Phone: 517-563-8247
  • Fax:

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:
Title or Position:
Credential:
Phone: