Provider Demographics
NPI:1992746762
Name:MAIXNER, JAMES MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:MAIXNER
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 1:1400 10TH AVE. S.W.
Mailing Address - Street 2:P.O. BOX 854
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-0854
Mailing Address - Country:US
Mailing Address - Phone:319-352-5222
Mailing Address - Fax:319-352-5225
Practice Address - Street 1:1400 10TH AVE. S.W.
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-0854
Practice Address - Country:US
Practice Address - Phone:319-352-5222
Practice Address - Fax:319-352-5225
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0041434Medicaid