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General NPI Number Information
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NPI Number | 1578314084
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Entity Type | Individual
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Provider Name | MAXWELL WEITZEL BEHREND DDS
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Gender | Male
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 2481 EXECUTIVE DR
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City | EAST TROY
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State | WI
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Zip | 53120-2579
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Country | US
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Telephone | 262-642-5695
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Fax |
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Provider Business Mailing Address
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Address Line | 441 E ERIE ST UNIT 325
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City | MILWAUKEE
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State | WI
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Zip | 53202-6103
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Country | US
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Telephone | 219-299-3089
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Fax |
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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 | 6001479-15
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License Number State | WI
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