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General NPI Number Information
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NPI Number | 1811041767
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Entity Type | Individual
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Provider Name | JAMES GUYBERT MADDOX D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 1517 CUMBERLAND AVE
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City | MIDDLESBORO
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State | KY
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Zip | 40965-1222
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Country | US
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Telephone | 606-248-7661
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Fax | 606-242-2749
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Provider Business Mailing Address
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Address Line | 1517 CUMBERLAND AVE
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City | MIDDLESBORO
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State | KY
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Zip | 40965-1222
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Country | US
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Telephone | 606-248-7661
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Fax | 606-242-2749
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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 | KY4615
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | KY4615
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | KY4615
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License Number State | KY
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