Provider Demographics
NPI:1477955458
Name:MAZE FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:MAZE FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-362-5220
Mailing Address - Street 1:601 MILL ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVLLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-3440
Mailing Address - Country:US
Mailing Address - Phone:765-362-5220
Mailing Address - Fax:765-362-6393
Practice Address - Street 1:601 MILL ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVLLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3440
Practice Address - Country:US
Practice Address - Phone:765-362-5220
Practice Address - Fax:765-362-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-21
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty