Max Moncayo DDS Dental Corporation

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

53926 Issued in CA

Legal business name

MAX MONCAYO DDS DENTAL CORPORATION

Practice address

881 Alma Real Dr
Suite T4
Pacific Palisades, CA 90272-3731

Phone

(310) 459-0014

NPI assigned

Apr 14, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Max Paul Moncayo, DDSNPI 1588636310

Title

President

Phone

(310) 459-0014

Specialties & licenses 1

Addresses

Other names 1

• Palisades Surgical Arts Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Max Paul Moncayo, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Pacific Palisades, CA
  • NPI 1588636310
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492128000000",
    "number": "1053845172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "881 ALMA REAL DR",
            "address_2": "SUITE T4",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723731",
            "telephone_number": "310-459-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "881 ALMA REAL DR",
            "address_2": "SUITE T4",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723731",
            "telephone_number": "310-459-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAX MONCAYO DDS DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-14",
        "last_updated": "2017-04-14",
        "status": "A",
        "authorized_official_last_name": "MONCAYO",
        "authorized_official_first_name": "MAX",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-459-0014",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "53926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palisades Surgical Arts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Debra Maltenfort, MD
• Diedra R Manns, P.T.
• Mark R Sawusch MD Inc
• Ann M Marraccini, P.T.
• Tracy G Marsh, PH.D.
• Darby McCullough
• Bernadette Catherine McDonnell, PT, LCCE
• Danielle McLellan-Bujnak, ICPD
• Krystyna McNicoll, MD
• Joanne Gail Mednick, MFT

• Oral and Maxillofacial Surgery (Dentist) in Pacific Palisades, CA
• Providers in Pacific Palisades, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.