Provider Demographics
NPI:1194839340
Name:FLEMING, MAXWELL U JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:U
Last Name:FLEMING
Suffix:JR
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 1:3721 S OLIVE
Mailing Address - Street 2:STE B
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603
Mailing Address - Country:US
Mailing Address - Phone:870-536-9800
Mailing Address - Fax:870-536-9804
Practice Address - Street 1:3721 S OLIVE
Practice Address - Street 2:STE B
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:870-536-9800
Practice Address - Fax:870-536-9804
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
841822OtherUNITED CONCORDIA
AR103050608Medicaid
AR58603OtherBLUE CROSS BLUE SHIELD