Provider Demographics
NPI:1861911596
Name:MAPLE FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:MAPLE FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-920-4951
Mailing Address - Street 1:1548 W MAUMEE ST STE A
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1382
Mailing Address - Country:US
Mailing Address - Phone:517-920-4951
Mailing Address - Fax:517-759-4027
Practice Address - Street 1:1548 W MAUMEE ST STE A
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1382
Practice Address - Country:US
Practice Address - Phone:517-920-4951
Practice Address - Fax:517-759-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental