Individual
DR. BLAKE JEREMY MAXFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(804) 828-0843
Mailing address
520 N 12TH ST, RICHMOND, VA 23298-5064
(804) 828-0843
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0
VA
Other
Enumeration date
08/29/2007
Last updated
08/29/2007
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