Provider Demographics
NPI:1770748915
Name:MAZE, HEATHER L (DDS)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:MAZE
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 1:4645 MEDINA ROAD
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321
Mailing Address - Country:US
Mailing Address - Phone:330-668-1016
Mailing Address - Fax:330-668-0001
Practice Address - Street 1:4645 MEDINA RD
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-3180
Practice Address - Country:US
Practice Address - Phone:330-668-1016
Practice Address - Fax:330-668-0001
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist