# CHARLES B. MAXWELL, DMD, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851345557
- **Authorized official:** DR. CHARLES B MAXWELL DMD (OWNER)
- **Authorized official phone:** (843) 386-2833

## Contact information

- **Practice address:** 144 EAST BROADWAY ST., JOHNSONVILLE, SC 29555-0297
- **Practice address phone:** (843) 386-2833
- **Practice address fax:** (843) 386-2279
- **Mailing address:** 144 EAST BROADWAY ST., PO BOX 297, JOHNSONVILLE, SC 29555-0297
- **Mailing address phone:** (843) 386-2833
- **Mailing address fax:** (843) 386-2279

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 2117 | SC | Yes |

## Other

- **Enumeration date:** 05/19/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | Z2117-4 | — | SC |