Provider Demographics
NPI:1497752422
Name:MAXEY, JIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:
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 1:5930 E 31ST ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-742-2424
Mailing Address - Fax:918-742-1253
Practice Address - Street 1:5930 E 31ST ST
Practice Address - Street 2:SUITE 600
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-742-2424
Practice Address - Fax:918-742-1253
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:2005-07-06
Deactivation Code:
Reactivation Date:2006-12-05
Provider Licenses
StateLicense IDTaxonomies
OK35691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice