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General NPI Number Information
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NPI Number | 1912557026
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Entity Type | Organization
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Legal Business Name | AMANDA L. MAIZE, DMD, LLC
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 12904 GRAND BLVD
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City | CARMEL
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State | IN
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Zip | 46032-5256
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Country | US
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Telephone | 262-749-4119
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Fax |
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Provider Business Mailing Address
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Address Line | 12904 GRAND BLVD
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City | CARMEL
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State | IN
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Zip | 46032-5256
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Country | US
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Telephone | 262-749-4119
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | AMANDA MAIZE
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Credential | DMD
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Telephone | 262-749-4119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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