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General NPI Number Information
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NPI Number | 1578789095
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Entity Type | Organization
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Legal Business Name | MAXWELLO INC.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 10223 BROADWAY ST SUITE D-1
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City | PEARLAND
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State | TX
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Zip | 77584-7880
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Country | US
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Telephone | 713-436-2522
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Fax | 713-436-2452
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Provider Business Mailing Address
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Address Line | 10223 BROADWAY ST SUITE D-1
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City | PEARLAND
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State | TX
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Zip | 77584-7881
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Country | US
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Telephone | 713-436-2522
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Fax | 713-436-2452
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LETITIA PLUMMER
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Credential | DDS
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Telephone | 713-436-2522
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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 | TX 20000
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License Number State | TX
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