Provider Demographics
NPI:1952491144
Name:ACHTAU, MAX L (DMD, MAGD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:L
Last Name:ACHTAU
Suffix:
Gender:M
Credentials:DMD, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 STATE RT 23
Mailing Address - Street 2:APT. A
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-3312
Mailing Address - Country:US
Mailing Address - Phone:973-875-7135
Mailing Address - Fax:973-875-8364
Practice Address - Street 1:717 STATE RT 23
Practice Address - Street 2:APT. A
Practice Address - City:SUSSEX
Practice Address - State:NJ
Practice Address - Zip Code:07461-3312
Practice Address - Country:US
Practice Address - Phone:973-875-7135
Practice Address - Fax:973-875-8364
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist