Provider Demographics
NPI:1700411733
Name:DANSO, MAXINE (DDS)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:DANSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 VICTORY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7464
Mailing Address - Country:US
Mailing Address - Phone:989-430-6311
Mailing Address - Fax:
Practice Address - Street 1:1811 HIGHWAY 287 N STE 160
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7571
Practice Address - Country:US
Practice Address - Phone:817-405-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40260122300000X
MI29016004101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist