Provider Demographics
NPI:1700161395
Name:DAVID R. MAXWELL, DDS, P.C.
Entity Type:Organization
Organization Name:DAVID R. MAXWELL, DDS, P.C.
Other - Org Name:MAXIMUM SMILES DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROKETHA
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-771-0058
Mailing Address - Street 1:2245 RIDGE ROAD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087
Mailing Address - Country:US
Mailing Address - Phone:214-771-0058
Mailing Address - Fax:469-402-0135
Practice Address - Street 1:2245 RIDGE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5172
Practice Address - Country:US
Practice Address - Phone:214-771-0058
Practice Address - Fax:469-402-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22628261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180376902Medicaid