Basic Information
| Provider Information | |||||||||
| NPI: | 1639369358 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDON & SORROW ORAL AND MAXILLOFACIAL SURGERY PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 683 ROBINSON RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492031155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177870417 | ||||||||
| FaxNumber: | 5177875536 | ||||||||
| Practice Location | |||||||||
| Address1: | 683 ROBINSON RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492031155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177870417 | ||||||||
| FaxNumber: | 5177875536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 01/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | CARDON | ||||||||
| AuthorizedOfficialFirstName: | ORSON | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5177870417 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | OC016653 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.