Provider Demographics
NPI:1306349782
Name:MAXWELL, WILLIS ELBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:ELBERT
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 1:2034 PASEO DEL PRADO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3749
Mailing Address - Country:US
Mailing Address - Phone:915-525-3737
Mailing Address - Fax:
Practice Address - Street 1:14509 HORIZON BLVD
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-8564
Practice Address - Country:US
Practice Address - Phone:915-852-5111
Practice Address - Fax:915-852-1056
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty