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General NPI Number Information
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NPI Number | 1841676822
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Entity Type | Individual
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Provider Name | MARIAM ROMMEL MAIZI DDS
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Gender | Female
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 31201 CHICAGO RD S STE A301
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City | WARREN
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State | MI
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Zip | 48093-5523
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Country | US
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Telephone | 586-434-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 31201 CHICAGO RD S STE A301
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City | WARREN
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State | MI
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Zip | 48093-5523
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Country | US
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Telephone | 586-434-4040
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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 | 29010211560
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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 | 5315071562
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License Number State | MI
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