Provider Demographics
NPI:1033188842
Name:MAXWELL, JAMES A JR (DDS,MS (R))
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:MAXWELL
Suffix:JR
Gender:M
Credentials:DDS,MS (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2737
Mailing Address - Country:US
Mailing Address - Phone:937-399-4476
Mailing Address - Fax:937-399-9623
Practice Address - Street 1:2210 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2737
Practice Address - Country:US
Practice Address - Phone:937-399-4476
Practice Address - Fax:937-399-9623
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0157801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0466839Medicaid
OH311107160026Medicaid
OH6082Medicaid
OH000000075860OtherANTHEM
OH311107160026Medicaid
OHT47437Medicare UPIN