# AMANDA L. MAIZE, DMD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912557026
- **Authorized official:** AMANDA MAIZE DMD (DENTIST)
- **Authorized official phone:** (262) 749-4119

## Contact information

- **Practice address:** 12904 GRAND BLVD, CARMEL, IN 46032-5256
- **Practice address phone:** (262) 749-4119
- **Mailing address:** 12904 GRAND BLVD, CARMEL, IN 46032-5256
- **Mailing address phone:** (262) 749-4119

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/19/2019
- **Last updated:** 12/02/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1063864601 | NPI TYPE 1 | IN |
| 01 | — | 12012630A | IN DENTAL LICENSE | IN |