MEDICARE: DR. BRIAN MAIZI DDS

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
1	122300000X	Dentist	2901022555	MI

General Provider Information

NPI Number	:	1871945170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN MAIZI DDS

Provider Business Mailing Address
First Line	:	31201 CHICAGO RD S STE A301
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5523
Country	:	US
Telephone Number	:	248-792-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	31201 CHICAGO RD S STE A301
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5523
Country	:	US
Telephone Number	:	586-434-4040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	09/10/2021

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