Active NPI
Maximillian Anton Menacher Jr.
- Dentist
- Eau Claire, WI
National Provider Identifier
1659569549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4630
- Practice address
- 1025 N Hastings Way
Suite 3
Eau Claire, WI 54703-1898 - Phone
- (717) 832-8287
- Fax
- (715) 832-8031
- NPI assigned
- Oct 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4630 | WI | Primary |
Addresses
Primary practice location
1025 N Hastings Way
Suite 3
Eau Claire, WI 54703-1898
Mailing address
1025 N Hastings Way
Suite 3
Eau Claire, WI 54703-1898
Phone (717) 832-8287
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4630 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191542400000",
"number": "1659569549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 N HASTINGS WAY",
"address_2": "SUITE 3",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547031898",
"telephone_number": "717-832-8287",
"fax_number": "715-832-8031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 N HASTINGS WAY",
"address_2": "SUITE 3",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547031898",
"telephone_number": "717-832-8287",
"fax_number": "715-832-8031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENACHER",
"first_name": "MAXIMILLIAN",
"middle_name": "ANTON",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-05",
"last_updated": "2007-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "4630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eau Claire, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.