Healthcare Provider Details

I. General information

NPI: 1326957523
Provider Name (Legal Business Name): WAHOSKE DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E 3RD AVE STE 112
DURANGO CO
81301-5046
US

IV. Provider business mailing address

4212 SEDONA CT
FARMINGTON NM
87401-9280
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-0682
  • Fax:
Mailing address:
  • Phone: 225-335-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MAX WAHOSKE
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 225-335-2601