Active NPI
Ashley Maxam, DMD
- Dentist
- Marion, IL
National Provider Identifier
1124259130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019-028085
- Practice address
- 1501 S Carbon St
Marion, IL 62959-1435 - Phone
- (618) 997-7273
- Fax
- (618) 997-8978
- NPI assigned
- Aug 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019-028085 | IL | Primary |
Addresses
Primary practice location
1501 S Carbon St
Marion, IL 62959-1435
Mailing address
109 California St
PO Box 577
Carterville, IL 62918-1923
Phone (618) 985-8221
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019-028085 | Other | IL | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-028085 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319155200000",
"number": "1124259130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 CALIFORNIA ST",
"address_2": "PO BOX 577",
"city": "CARTERVILLE",
"state": "IL",
"postal_code": "629181923",
"telephone_number": "618-985-8221",
"fax_number": "618-985-6860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 S CARBON ST",
"city": "MARION",
"state": "IL",
"postal_code": "629591435",
"telephone_number": "618-997-7273",
"fax_number": "618-997-8978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXAM",
"first_name": "ASHLEY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-07",
"last_updated": "2011-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019-028085",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "019-028085",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.