Max Warren Wahoske, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DD5514 Issued in NM

Practice address

3150 E Main St Ste A55
Farmington, NM 87402-7630

Phone

(505) 436-3569

NPI assigned

Aug 24, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1245907641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 SEDONA CT",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874019280",
            "telephone_number": "225-335-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 E MAIN ST STE A55",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874027630",
            "telephone_number": "505-436-3569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHOSKE",
        "first_name": "MAX",
        "middle_name": "WARREN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-24",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD5514",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD5514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Villars
• Jean Villeneuve
• Pablo Viramontes IV, RPH
• Bruce Douglas Volkerding, DDS
• Taylor M. Wade, MD
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Wal-Mart Stores East, LP.
• Walgreen Co

• Dentist in Farmington, NM
• Providers in Farmington, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; 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.