Provider Demographics
NPI:1457930836
Name:SHUMAKE, MAXIMILIAN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAXIMILIAN
Middle Name:JAMES
Last Name:SHUMAKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 E STARLIGHT WAY UNIT 246
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6142
Mailing Address - Country:US
Mailing Address - Phone:239-777-6788
Mailing Address - Fax:
Practice Address - Street 1:10615 N HAYDEN RD STE C-104
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5734
Practice Address - Country:US
Practice Address - Phone:480-905-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD0115301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty