Healthcare Provider Details

I. General information

NPI: 1871942656
Provider Name (Legal Business Name): MACY MAI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2016
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 LIVERNOIS RD
TROY MI
48083-1664
US

IV. Provider business mailing address

16798 SUMMIT VISTA DR
SAN DIEGO CA
92127-3434
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number100466
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901602761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: