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General NPI Number Information
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NPI Number | 1588284046
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Entity Type | Individual
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Provider Name | RITA MAIZY
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Gender | Female
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 2792 PACKARD RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1932
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Country | US
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Telephone | 734-645-6548
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Fax |
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Provider Business Mailing Address
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Address Line | 9266 NORTHERN AVE
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City | PLYMOUTH
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State | MI
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Zip | 48170-4046
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Country | US
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Telephone | 248-854-4638
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901600493
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901600493APP20
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901600493APP20
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901600493
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License Number State | MI
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