Individual
DR. PAUL JEAN MAXWELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
916 W 10TH ST, ALLIANCE, NE 69301-2858
(308) 762-6131
(308) 762-6132
Mailing address
1839 EMERSON AVE, ALLIANCE, NE 69301-2273
(308) 760-0001
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4060
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05107
BLUE CROSS
TX
01
—
76-003535
TIN
NE
05
—
76-00353500
—
NE
Enumeration date
05/16/2007
Last updated
07/08/2007
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