Provider Demographics
NPI:1689438384
Name:EUBANKS, MAXIE ANNETTE (CRDH)
Entity Type:Individual
Prefix:
First Name:MAXIE
Middle Name:ANNETTE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 MICHELE DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-3308
Mailing Address - Country:US
Mailing Address - Phone:850-381-2707
Mailing Address - Fax:
Practice Address - Street 1:1022 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2429
Practice Address - Country:US
Practice Address - Phone:850-381-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH21498124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist