MEDICARE: DR. JAMES A MAXWELL JR. DDS,MS (R)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30-015780	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000075860	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1033188842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES A MAXWELL JR. DDS,MS (R)

Provider Business Mailing Address
First Line	:	2210 OLYMPIC ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-2737
Country	:	US
Telephone Number	:	937-399-4476
Fax Number	:	937-399-9623

Provider Business Practice Location Address
First Line	:	2210 OLYMPIC ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-2737
Country	:	US
Telephone Number	:	937-399-4476
Fax Number	:	937-399-9623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	07/09/2007

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