Provider Demographics
NPI:1326411638
Name:ZEITZ, CAROLYNN ANN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYNN
Middle Name:ANN
Last Name:ZEITZ
Suffix:
Gender:F
Credentials:RDH
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:DEPARTMENT OF PEDIATRIC DENTISTRY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2576
Mailing Address - Country:US
Mailing Address - Phone:313-494-6792
Mailing Address - Fax:313-494-6842
Practice Address - Street 1:2700 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:DEPARTMENT OF PEDIATRIC DENTISTRY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2576
Practice Address - Country:US
Practice Address - Phone:313-494-6792
Practice Address - Fax:313-494-6842
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2902013814124Q00000X
MI2903002147126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant