Provider Demographics
NPI:1093187312
Name:DOYEL MAXUS LLC
Entity Type:Organization
Organization Name:DOYEL MAXUS LLC
Other - Org Name:MAXUS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:DOYEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-334-0930
Mailing Address - Street 1:20285 SW TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2302
Mailing Address - Country:US
Mailing Address - Phone:503-334-0930
Mailing Address - Fax:503-334-0931
Practice Address - Street 1:20285 SW TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-2302
Practice Address - Country:US
Practice Address - Phone:503-334-0930
Practice Address - Fax:503-334-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty