Provider Demographics
NPI:1629299235
Name:D'ORAZIO, ROBERT MAXWELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MAXWELL
Last Name:D'ORAZIO
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 1:1950 CHESLEY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4817
Mailing Address - Country:US
Mailing Address - Phone:586-979-1900
Mailing Address - Fax:586-979-1991
Practice Address - Street 1:1950 CHESLEY DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4817
Practice Address - Country:US
Practice Address - Phone:586-979-1900
Practice Address - Fax:586-979-1991
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI139450122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1955064840OtherBCBSM MEDICAL
MID139450OtherBCBSM DENTAL