Provider Demographics
NPI:1932136561
Name:MAXFIELD, JAY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:B
Last Name:MAXFIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 E TUSCARAWAS ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-2953
Mailing Address - Country:US
Mailing Address - Phone:330-454-2000
Mailing Address - Fax:330-454-6184
Practice Address - Street 1:1950 E TUSCARAWAS ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-2953
Practice Address - Country:US
Practice Address - Phone:330-454-2000
Practice Address - Fax:330-454-6184
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0139351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2381051Medicaid