Provider Demographics
NPI:1922195924
Name:MAXWELL, CHARLES ELLIOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ELLIOTT
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:133 TOWNE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3493
Mailing Address - Country:US
Mailing Address - Phone:843-448-1621
Mailing Address - Fax:843-903-3840
Practice Address - Street 1:133 TOURNE CENTRE PARKWAY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-448-1621
Practice Address - Fax:843-903-3840
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery