Provider Demographics
NPI:1366506602
Name:MAX, TERRY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:G
Last Name:MAX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N FEDERAL HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-4994
Mailing Address - Country:US
Mailing Address - Phone:561-997-6622
Mailing Address - Fax:561-995-6984
Practice Address - Street 1:5455 N FEDERAL HWY
Practice Address - Street 2:SUITE D
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4994
Practice Address - Country:US
Practice Address - Phone:561-997-6622
Practice Address - Fax:561-995-6984
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL85721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice