Organization
AMANDA L. MAIZE, DMD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA MAIZE DMD (DENTIST)
(262) 749-4119
Entity
Organization
Contact information
Practice address
12904 GRAND BLVD, CARMEL, IN 46032-5256
(262) 749-4119
Mailing address
12904 GRAND BLVD, CARMEL, IN 46032-5256
(262) 749-4119
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063864601
NPI TYPE 1
IN
01
—
12012630A
IN DENTAL LICENSE
IN
Enumeration date
09/19/2019
Last updated
12/02/2020
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