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General NPI Number Information
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NPI Number | 1700161395
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Entity Type | Organization
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Legal Business Name | DAVID R. MAXWELL, DDS, P.C.
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Dates
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Enumeration Date | 10/15/2011
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Last Update Date | 10/15/2011
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Provider Practice Location Address
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Address Line | 2245 RIDGE RD SUITE 125
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City | ROCKWALL
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State | TX
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Zip | 75087-5172
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Country | US
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Telephone | 214-771-0058
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Fax | 469-402-0135
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Provider Business Mailing Address
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Address Line | 2245 RIDGE ROAD SUITE 125
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City | ROCKWALL
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State | TX
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Zip | 75087
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Country | US
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Telephone | 214-771-0058
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Fax | 469-402-0135
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. DAVID ROKETHA MAXWELL
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Credential | DDS
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Telephone | 214-771-0058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22628
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License Number State | TX
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