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General NPI Number Information
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NPI Number | 1053464560
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Entity Type | Organization
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Legal Business Name | DR. CLYDE A. MAXWELL JR, PA
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 303 E LEA BLVD
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City | WILMINGTON
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State | DE
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Zip | 19802-2353
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Country | US
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Telephone | 302-765-3373
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Fax | 302-765-3379
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Provider Business Mailing Address
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Address Line | 303 E LEA BLVD
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City | WILMINGTON
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State | DE
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Zip | 19802-2353
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Country | US
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Telephone | 302-476-8896
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CLYDE A MAXWELL JR.
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Credential | DDS
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Telephone | 302-476-8896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G1-0001159
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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