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Organization
BENNETT & MAXWELL FAMILY DENTISTRY
Active
Organization
BENNETT & MAXWELL FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS COURTNEY MAXWELL DMD (OWNER)
(229) 671-1900
Entity
Organization
Contact information
Practice address
2415 ANDOVER DR, VALDOSTA, GA 31602-1280
(229) 671-1900
(229) 671-1999
Mailing address
2415 ANDOVER DR, VALDOSTA, GA 31602-1280
(229) 671-1900
(229) 671-1999
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
11534
GA
122300000X
Dentist
Primary
11562
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000961276A
—
GA
05
—
000963256A
—
GA
Enumeration date
10/08/2008
Last updated
10/08/2008
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