Provider Demographics
NPI:1134303613
Name:GREGORY M. MAXSON D.D.S., P.C.
Entity Type:Organization
Organization Name:GREGORY M. MAXSON D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAXSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-485-4629
Mailing Address - Street 1:1500 W SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1380
Mailing Address - Country:US
Mailing Address - Phone:517-485-5629
Mailing Address - Fax:517-485-0169
Practice Address - Street 1:1500 W SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1380
Practice Address - Country:US
Practice Address - Phone:517-485-5629
Practice Address - Fax:517-485-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty