Provider Demographics
NPI:1518753086
Name:MAKSIM MONTATSKIY DMD PC
Entity type:Organization
Organization Name:MAKSIM MONTATSKIY DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTATSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-886-4255
Mailing Address - Street 1:4 N DEER POINT RD STE 1002
Mailing Address - Street 2:
Mailing Address - City:HAINESVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3814
Mailing Address - Country:US
Mailing Address - Phone:847-886-4255
Mailing Address - Fax:
Practice Address - Street 1:4 N DEER POINT RD STE 1002
Practice Address - Street 2:
Practice Address - City:HAINESVILLE
Practice Address - State:IL
Practice Address - Zip Code:60030-3814
Practice Address - Country:US
Practice Address - Phone:847-886-4255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-19
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty