David Roketha Maxwell, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22628 Issued in TX

Practice address

2922B Martin Luther King Jr Blvd
Dallas, TX 75215

Phone

(214) 425-2686

Fax

(214) 426-6813

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204502400000",
    "number": "1194749929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 DAYBREAK DR",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750327261",
            "telephone_number": "214-771-0167",
            "fax_number": "214-771-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2922B MARTIN LUTHER KING JR BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75215",
            "telephone_number": "214-425-2686",
            "fax_number": "214-426-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "DAVID",
        "middle_name": "ROKETHA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2008-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130713406",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "QQ04",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18037601",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130713409",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL INSURANCE CO",
            "identifier": "G60266-01",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maxum Health Services Corp
• Kristen Annette Maxvill, PHARM.D., BCPS
• Autumn Maxwell
• Christine Elizabeth Maxwell
• Daniel Maxwell, M.D.
• Jenny Maxwell, NP
• Megan Gentry Maxwell, M.D.
• Melissa Maxwell, MS, RD, LD
• Shirley Maxwell
• So-Van Ho Maxwell

• General Practice Dentistry in Dallas, TX
• Providers in Dallas, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; 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.