Organization
CHARLES B. MAXWELL, DMD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES B MAXWELL DMD (OWNER)
(843) 386-2833
Entity
Organization
Contact information
Practice address
144 EAST BROADWAY ST., JOHNSONVILLE, SC 29555-0297
(843) 386-2833
(843) 386-2279
Mailing address
144 EAST BROADWAY ST., PO BOX 297, JOHNSONVILLE, SC 29555-0297
(843) 386-2833
(843) 386-2279
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2117
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z2117-4
—
SC
Enumeration date
05/19/2006
Last updated
08/22/2020
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