Healthcare Provider Details

I. General information

NPI: 1386796134
Provider Name (Legal Business Name): LARRY MAJZNERSKI, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 44TH ST SW
WYOMING MI
49509-4483
US

IV. Provider business mailing address

1416 44TH ST SW
WYOMING MI
49509-4483
US

V. Phone/Fax

Practice location:
  • Phone: 616-531-1811
  • Fax: 616-531-0624
Mailing address:
  • Phone: 616-531-1811
  • Fax: 616-531-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberL545016
License Number StateMI

VIII. Authorized Official

Name: LARRY MAJZNERSKI
Title or Position: OWNER
Credential: DDS
Phone: 616-531-1811