Maximilian James Shumake, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D011530 Issued in AZ

Practice address

10615 N Hayden Rd Ste C-104
Scottsdale, AZ 85260-5734

Phone

(480) 905-7171

NPI assigned

Apr 5, 2021

Last updated

Aug 4, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Justin Waters PLLC

  • Dental Clinic/Center
  • Scottsdale, AZ
  • NPI 1023827391
  NPD (past)

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1457930836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7950 E STARLIGHT WAY UNIT 246",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852506142",
            "telephone_number": "239-777-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10615 N HAYDEN RD STE C-104",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852605734",
            "telephone_number": "480-905-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMAKE",
        "first_name": "MAXIMILIAN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-05",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D011530",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Maria Shuey, RN
• Chandani Harish Shukla
• Shemal Shukla, DMD
• Vershalee Shukla, MD
• Robert M Shull, M.D.
• Douglas A Shuman, MD
• Anna Shuqom, MA, LPC
• Shurveer International, Inc (Advanced Health & Wellness Center)
• Alexander Raymond Shusko Jr.
• Erin Hong Shusko, DDS

• General Practice Dentistry in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; 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.