Provider Demographics
NPI:1205043791
Name:MAXWELL, PAUL JEAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEAN
Last Name:MAXWELL
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 1:1839 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2273
Mailing Address - Country:US
Mailing Address - Phone:308-760-0001
Mailing Address - Fax:
Practice Address - Street 1:916 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2858
Practice Address - Country:US
Practice Address - Phone:308-762-6131
Practice Address - Fax:308-762-6132
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE40601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE76-003535OtherTIN
NE76-00353500Medicaid
TX05107OtherBLUE CROSS