Provider Demographics
NPI:1831128438
Name:STRICKLAND, MAXINE (DMD)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:STRICKLAND
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 1:67 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-2031
Mailing Address - Country:US
Mailing Address - Phone:973-818-3282
Mailing Address - Fax:
Practice Address - Street 1:333 CLINTON PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-1563
Practice Address - Country:US
Practice Address - Phone:973-679-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01689208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ063701Medicare ID - Type UnspecifiedFQHC