Provider Demographics
NPI:1285869875
Name:MAXWELL, JOSHUA FARLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:FARLEY
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16005 US ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-9070
Mailing Address - Country:US
Mailing Address - Phone:606-739-0403
Mailing Address - Fax:
Practice Address - Street 1:16005 US ROUTE 23
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-9070
Practice Address - Country:US
Practice Address - Phone:606-739-0403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24532122300000X
KY110231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherINSURANCE