Provider Demographics
NPI:1194485268
Name:MINA MAKRAM DDS LLC
Entity type:Organization
Organization Name:MINA MAKRAM DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-979-8568
Mailing Address - Street 1:466 POMPTON AVE STE 6/7
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1812
Mailing Address - Country:US
Mailing Address - Phone:732-979-8568
Mailing Address - Fax:
Practice Address - Street 1:466 POMPTON AVE STE 6/7
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1812
Practice Address - Country:US
Practice Address - Phone:973-857-0567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty