Healthcare Provider Details

I. General information

NPI: 1588131528
Provider Name (Legal Business Name): JAMES A MAXWELL JR DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 OLYMPIC ST
SPRINGFIELD OH
45503-2737
US

IV. Provider business mailing address

2210 OLYMPIC ST
SPRINGFIELD OH
45503-2737
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-4476
  • Fax: 937-399-9623
Mailing address:
  • Phone: 937-399-4476
  • Fax: 937-399-9623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES ALVIN MAXWELL JR.
Title or Position: OWNER
Credential: DDS,MS (R)
Phone: 937-399-4476