Provider Demographics
NPI:1588636310
Name:MONCAYO, MAX PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:PAUL
Last Name:MONCAYO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 SAN JOAQUIN PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5971
Mailing Address - Country:US
Mailing Address - Phone:909-908-9660
Mailing Address - Fax:
Practice Address - Street 1:881 ALMA REAL DR STE T4
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3743
Practice Address - Country:US
Practice Address - Phone:310-459-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD52291223P0106X
CA539261223S0112X
CO002050241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology