Provider Demographics
NPI:1659569549
Name:MENACHER, MAXIMILLIAN ANTON JR
Entity Type:Individual
Prefix:DR
First Name:MAXIMILLIAN
Middle Name:ANTON
Last Name:MENACHER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N HASTINGS WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-1898
Mailing Address - Country:US
Mailing Address - Phone:717-832-8287
Mailing Address - Fax:715-832-8031
Practice Address - Street 1:1025 N HASTINGS WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-1898
Practice Address - Country:US
Practice Address - Phone:717-832-8287
Practice Address - Fax:715-832-8031
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist