Provider Demographics
NPI:1073665824
Name:MAJZNERSKI, LARRY (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MAJZNERSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 44TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4483
Mailing Address - Country:US
Mailing Address - Phone:616-531-1811
Mailing Address - Fax:616-531-0674
Practice Address - Street 1:1416 44TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4483
Practice Address - Country:US
Practice Address - Phone:616-531-1811
Practice Address - Fax:616-531-0674
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL545017122300000X
MIL5450161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics