Maxham, Marcie Mliss
Maxham, Marcie Mliss is an individual health care provider with primary practice located at 205 South Street , Fort Bragg CA 95437-5540. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Maxham, Marcie Mliss can be contacted via phone (707) 964-1251.Contact Information
Primary practice address
205 South Street
Fort Bragg CA 95437-5540
Phone: (707) 964-1251
Fax: (707) 961-2722
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | DG031665 | California |
Profile Details
| NPI number | 1568594216 |
|---|---|
| LBN Legal business name | Maxham, Marcie Mliss |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 9th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568594216 | NPPES |
| California | MEDICAID | FHC03967F |
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