Bruce Craig Maxwell, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2006000187 Issued in MO

Practice address

747 W Broadway St
West Plains, MO 65775-2368

Phone

(417) 256-2525

Fax

(417) 256-7546

NPI assigned

Apr 20, 2006

Last updated

Sep 18, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Comfort Dental Inc

  • Dentist
  • West Plains, MO
  • NPI 1053453233
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1184689069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 W BROADWAY ST",
            "address_2": "PO BOX 330",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752368",
            "telephone_number": "417-256-2525",
            "fax_number": "417-256-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 W BROADWAY ST",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752368",
            "telephone_number": "417-256-2525",
            "fax_number": "417-256-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "BRUCE",
        "middle_name": "CRAIG",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2006000187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407595800",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405408501",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Martin
• Robert Allen Martin, MD
• Karlee Marvin, RN
• Robyn Dell Massey, MCDCCC-SLP
• Parker Daniel Matteson, DPT
• Ashley Mayberry
• Deborah June McCart, LCSW
• Johnathan McClure
• John M McCormack, M.D.
• Jacob Henry McCrackin

• Dentist in West Plains, MO
• Providers in West Plains, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.