Provider Demographics
NPI:1760562599
Name:MAXWELL, MARK F (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:1441 AVOCADO AVE
Mailing Address - Street 2:SUITE 703
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7721
Mailing Address - Country:US
Mailing Address - Phone:949-640-0203
Mailing Address - Fax:949-640-2126
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7721
Practice Address - Country:US
Practice Address - Phone:949-640-0203
Practice Address - Fax:949-640-2126
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA314951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics