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General NPI Number Information
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NPI Number | 1194749929
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Entity Type | Individual
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Provider Name | DAVID ROKETHA MAXWELL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 2922B MARTIN LUTHER KING JR BLVD
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City | DALLAS
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State | TX
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Zip | 75215
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Country | US
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Telephone | 214-425-2686
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Fax | 214-426-6813
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Provider Business Mailing Address
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Address Line | 2421 DAYBREAK DR
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City | ROCKWALL
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State | TX
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Zip | 75032-7261
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Country | US
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Telephone | 214-771-0167
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Fax | 214-771-0167
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22628
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License Number State | TX
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