Provider Demographics
NPI:1558596791
Name:MAXHAM, JANICE GOULD (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:GOULD
Last Name:MAXHAM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-0432
Mailing Address - Country:US
Mailing Address - Phone:207-778-2006
Mailing Address - Fax:
Practice Address - Street 1:145 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1924
Practice Address - Country:US
Practice Address - Phone:207-778-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH353124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist