MEDICARE: DR. GEORGE H. MAXFIELD D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	2308	NH
2	1223P0300X	Periodontics	14549	MA

General Provider Information

NPI Number	:	1033166186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE H. MAXFIELD D.M.D.

Provider Business Mailing Address
First Line	:	5 VILLAGER RD
Second Line	:
City	:	CHESTER
State	:	NH
Zip	:	03036-4035
Country	:	US
Telephone Number	:	603-887-6334
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 VILLAGER RD
Second Line	:
City	:	CHESTER
State	:	NH
Zip	:	03036-4035
Country	:	US
Telephone Number	:	603-887-6334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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