Healthcare Provider Details

I. General information

NPI: 1982371365
Provider Name (Legal Business Name): DENTAL DESIGN GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31201 CHICAGO RDS #A301
WARREN MI
48093
US

IV. Provider business mailing address

31201 CHICAGO RDS #A301
WARREN MI
48093
US

V. Phone/Fax

Practice location:
  • Phone: 586-434-4040
  • Fax:
Mailing address:
  • Phone: 586-434-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN MAIZI
Title or Position: PARTNER
Credential:
Phone: 248-792-1110