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General NPI Number Information
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NPI Number | 1811129919
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Entity Type | Individual
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Provider Name | MICHELLE KRISTIN MAAK DMD
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Gender | Female
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Dates
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Enumeration Date | 08/23/2009
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 6268 S 900 E STE 100
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-2497
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Country | US
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Telephone | 801-566-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 6268 S 900 E STE 100
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-2497
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Country | US
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Telephone | 801-566-5117
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 054597
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License Number State | NY
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