Healthcare Provider Details

I. General information

NPI: 1194656355
Provider Name (Legal Business Name): HAZLE MAXWELL RASTOGI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8159 CHALLIS RD
BRIGHTON MI
48116-7446
US

IV. Provider business mailing address

43025 W TWELVE MILE RD
NOVI MI
48377-3012
US

V. Phone/Fax

Practice location:
  • Phone: 248-478-3232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AMY MAXWELL
Title or Position: OWNER
Credential: DDS
Phone: 248-478-3232