Individual
BRUCE CRAIG MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
747 W BROADWAY ST, WEST PLAINS, MO 65775-2368
(417) 256-2525
(417) 256-7546
Mailing address
747 W BROADWAY ST, PO BOX 330, WEST PLAINS, MO 65775-2368
(417) 256-2525
(417) 256-7546
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2006000187
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405408501
—
MO
05
—
407595800
—
MO
Enumeration date
04/20/2006
Last updated
09/18/2013
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