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General NPI Number Information
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NPI Number | 1851771703
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Entity Type | Individual
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Provider Name | MAKSIM MONTATSKIY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 5439 DURAND AVE STE 210
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City | MOUNT PLEASANT
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State | WI
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Zip | 53406-5058
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Country | US
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Telephone | 262-583-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 1331 BRANDYWYN LN
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1105
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Country | US
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Telephone | 312-375-8622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.030546
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021.003011
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1001127-15
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License Number State | WI
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