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General NPI Number Information
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NPI Number | 1639369358
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Entity Type | Organization
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Legal Business Name | CARDON & SORROW ORAL AND MAXILLOFACIAL SURGERY PLC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 683 ROBINSON RD
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City | JACKSON
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State | MI
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Zip | 49203-1155
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Country | US
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Telephone | 517-787-0417
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Fax | 517-787-5536
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Provider Business Mailing Address
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Address Line | 683 ROBINSON RD
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City | JACKSON
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State | MI
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Zip | 49203-1155
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Country | US
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Telephone | 517-787-0417
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Fax | 517-787-5536
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | DR. ORSON P CARDON
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Credential | D.M.D.
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Telephone | 517-787-0417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | OC016653
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License Number State | MI
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