Provider Demographics
NPI:1710212600
Name:GAIZUTIS, MARIA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:D
Last Name:GAIZUTIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NORTH SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505
Mailing Address - Country:US
Mailing Address - Phone:810-232-9102
Mailing Address - Fax:
Practice Address - Street 1:2400 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-4442
Practice Address - Country:US
Practice Address - Phone:810-232-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist