| Charles B. Maxwell, Dmd, Pa | |
|
144 East Broadway St. Johnsonville SC 29555-0297 | |
| (843) 386-2833 | |
| (843) 386-2279 |
| Full Name | Charles B. Maxwell, Dmd, Pa |
|---|---|
| Speciality | Clinic/center |
| Location | 144 East Broadway St., Johnsonville, South Carolina |
| Authorized Official Name and Position | Charles B Maxwell (OWNER) |
| Authorized Official Contact | 8433862833 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles B. Maxwell, Dmd, Pa 144 East Broadway St. Po Box 297 Johnsonville SC 29555-0297 Ph: (843) 386-2833 | Charles B. Maxwell, Dmd, Pa 144 East Broadway St. Johnsonville SC 29555-0297 Ph: (843) 386-2833 |
| NPI Number | 1851345557 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851345557 | NPI | - | NPPES |
| Z2117-4 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2117 (South Carolina) | Primary |
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