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1245907641 NPI number — MAX WARREN WAHOSKE DMD

NPI Number: 1245907641
Health Care Provider/Practitioner: MAX WARREN WAHOSKE DMD

Information about “1245907641” NPI (MAX WARREN WAHOSKE DMD) exists in 1245907641 in HTML format HTML  |  1245907641 in plain Text format TXT  |  1245907641 in PDF (Portable Document Format) PDF  |  1245907641 in an XML format XML  formats.

NPI Number : 1245907641 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245907641",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WAHOSKE",
    "FirstName": "MAX",
    "MiddleName": "WARREN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4212 SEDONA CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FARMINGTON",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87401-9280",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "225-335-2601",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3150 E MAIN ST STE A55",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FARMINGTON",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87402-7630",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-436-3569",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/24/2021",
    "LastUpdateDate": "07/18/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "DD5514",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "DD5514",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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