Provider Demographics
NPI:1457462129
Name:MAXWELL, JAMES PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:MAXWELL
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 1:5710 WATAUGA RD
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3022
Mailing Address - Country:US
Mailing Address - Phone:817-281-2061
Mailing Address - Fax:
Practice Address - Street 1:5710 WATAUGA RD
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-3022
Practice Address - Country:US
Practice Address - Phone:817-281-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice