Provider Demographics
NPI:1003316837
Name:LIKAVEC-WITRI, MAYA (RDH)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:LIKAVEC-WITRI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:LIKAVEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30921 LEE FRANK LN
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2243
Mailing Address - Country:US
Mailing Address - Phone:989-400-0123
Mailing Address - Fax:
Practice Address - Street 1:26750 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1529
Practice Address - Country:US
Practice Address - Phone:313-531-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902018273124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist