Provider Demographics
NPI:1164553046
Name:MAXIMO, FRANKLIN BAUTISTA (DDS)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:BAUTISTA
Last Name:MAXIMO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3025
Mailing Address - Country:US
Mailing Address - Phone:740-439-4799
Mailing Address - Fax:740-439-1716
Practice Address - Street 1:1109 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3025
Practice Address - Country:US
Practice Address - Phone:740-439-4799
Practice Address - Fax:740-439-1716
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0193301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0832602Medicaid
OH2445563Medicaid