Provider Demographics
NPI:1740563295
Name:COMBS, MAXIE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAXIE
Middle Name:J
Last Name:COMBS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 WELLINGTON WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-223-4644
Mailing Address - Fax:859-224-8466
Practice Address - Street 1:527 WELLINGTON WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-223-4644
Practice Address - Fax:859-224-8466
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000806082OtherUNITED CONCORDIA-TRICARE