MEDICARE: DR. DAVID PAUL MAXWELL JR. DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	4572	WV

General Provider Information

NPI Number	:	1538800156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PAUL MAXWELL JR. DDS

Provider Business Mailing Address
First Line	:	150 BIRDS EYE VIEW DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26501-2297
Country	:	US
Telephone Number	:	304-439-1819
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 N PIKE ST
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1221
Country	:	US
Telephone Number	:	304-265-4600
Fax Number	:

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

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	06/06/2022

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