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NPI Code Detail

MEDICARE: HAZLE MAXWELL RASTOGI PLLC

MEDICARE: HAZLE MAXWELL RASTOGI PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1194656355
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAZLE MAXWELL RASTOGI PLLC
Provider Business Mailing Address
First Line : 43025 W TWELVE MILE RD
Second Line :
City : NOVI
State : MI
Zip : 48377-3012
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8159 CHALLIS RD
Second Line :
City : BRIGHTON
State : MI
Zip : 48116-7446
Country : US
Telephone Number : 248-478-3232
Fax Number :
Authorized Official
Title or Position : OWNER
Name : AMY MAXWELL
Credential : DDS
Telephone Number : 248-478-3232
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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