Provider Demographics
NPI:1356488860
Name:MAXFIELD, ROBERT G JR (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:MAXFIELD
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 1:256 POVERTY LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2702
Mailing Address - Country:US
Mailing Address - Phone:603-448-2651
Mailing Address - Fax:
Practice Address - Street 1:11 DUNNING ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2016
Practice Address - Country:US
Practice Address - Phone:603-542-2351
Practice Address - Fax:603-543-4116
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH 19201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice