Individual
DR. ASHLEY MAXAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1501 S CARBON ST, MARION, IL 62959-1435
(618) 997-7273
(618) 997-8978
Mailing address
109 CALIFORNIA ST, PO BOX 577, CARTERVILLE, IL 62918-1923
(618) 985-8221
(618) 985-6860
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-028085
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019-028085
STATE LICENSE NUMBER
IL
Enumeration date
08/07/2009
Last updated
10/21/2011
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