Healthcare Provider Details

I. General information

NPI: 1740194984
Provider Name (Legal Business Name): THE MAX DENTAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PEYTON PKWY
COLLIERVILLE TN
38017-9702
US

IV. Provider business mailing address

15660 DALLAS PKWY STE 925
DALLAS TX
75248-3323
US

V. Phone/Fax

Practice location:
  • Phone: 901-861-0031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMANDA LIGHTFOOT
Title or Position: DIRECTOR OF PAYER RELATIONS
Credential:
Phone: 214-702-0708