Provider Demographics
NPI:1891024956
Name:MAXWELL, JAMES WILLIAM JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:MAXWELL
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10000 WATSON ROAD
Mailing Address - Street 2:SOUTH BUILDING SUITE J
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126
Mailing Address - Country:US
Mailing Address - Phone:314-463-5655
Mailing Address - Fax:314-821-0381
Practice Address - Street 1:10000 WATSON ROAD, SOUTH BUILDING, SUITE J
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1854
Practice Address - Country:US
Practice Address - Phone:314-463-5655
Practice Address - Fax:314-821-0381
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020299031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice