Healthcare Provider Details

I. General information

NPI: 1689438384
Provider Name (Legal Business Name): MAXIE ANNETTE EUBANKS CRDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 HARRISON AVE
PANAMA CITY FL
32401-2429
US

IV. Provider business mailing address

336 MICHELE DR
PANAMA CITY FL
32404-3308
US

V. Phone/Fax

Practice location:
  • Phone: 850-381-2707
  • Fax:
Mailing address:
  • Phone: 850-381-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH21498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: