Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902018273 | MI |
NPI | 1003316837 |
---|---|
Provider Name | Maya Likavec-Witri |
First Address | Madison Heights, MI 48071-2243 |
Second Address | Redford, MI 48240-1529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2018 |
Last Update Date | 19/02/2018 |