Provider Demographics
NPI:1346268943
Name:MAXEY, BRIAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:MAXEY
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 1:3 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5709
Mailing Address - Country:US
Mailing Address - Phone:227-875-1881
Mailing Address - Fax:228-875-1883
Practice Address - Street 1:3 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5709
Practice Address - Country:US
Practice Address - Phone:227-875-1881
Practice Address - Fax:228-875-1883
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2088-841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics