Healthcare Provider Details

I. General information

NPI: 1639411283
Provider Name (Legal Business Name): MAX MEINERZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 WATERTOWN PLANK ROAD SUITE 100
ELM GROVE WI
53122
US

IV. Provider business mailing address

15285 WATERTOWN PLANK ROAD SUITE 200
ELM GROVE WI
53122
US

V. Phone/Fax

Practice location:
  • Phone: 262-784-7770
  • Fax: 262-784-8045
Mailing address:
  • Phone: 262-649-4900
  • Fax: 262-649-4844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7067-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: