Provider Demographics
NPI:1700517034
Name:MAXWELL, JUSTIN (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:UNION BRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21791-8107
Mailing Address - Country:US
Mailing Address - Phone:240-753-8034
Mailing Address - Fax:
Practice Address - Street 1:5018 DORSEY HALL DR STE 105
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7856
Practice Address - Country:US
Practice Address - Phone:410-740-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist