Individual
DR. KELLY M MAIXNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1001 E USA CIR, SUITE B, WASILLA, AK 99654-7198
(907) 373-6000
(907) 357-6878
Mailing address
PO BOX 521792, BIG LAKE, AK 99652-1792
(907) 373-6000
(907) 357-6878
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1248
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD5010
—
AK
Enumeration date
08/17/2007
Last updated
08/07/2013
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