Healthcare Provider Details

I. General information

NPI: 1801528088
Provider Name (Legal Business Name): MAXWELL ALEXANDER LOEW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SOUTH ST
CORYDON IA
50060-1724
US

IV. Provider business mailing address

614 PARKER ST
TRACY IA
50256-8558
US

V. Phone/Fax

Practice location:
  • Phone: 641-872-2514
  • Fax:
Mailing address:
  • Phone: 715-790-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10020
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: