Provider Demographics
NPI:1841717642
Name:MAXWELL U. FLEMING, JR., DDS
Entity type:Organization
Organization Name:MAXWELL U. FLEMING, JR., DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-536-9800
Mailing Address - Street 1:3721 S OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6756
Mailing Address - Country:US
Mailing Address - Phone:870-536-9800
Mailing Address - Fax:870-536-9804
Practice Address - Street 1:3721 S OLIVE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:870-536-9800
Practice Address - Fax:870-536-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2513261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103050608Medicaid