Provider Demographics
NPI:1285810036
Name:DR. MAK DENTAL CORP.
Entity type:Organization
Organization Name:DR. MAK DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-308-3933
Mailing Address - Street 1:1234 S GARFIELD AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5065
Mailing Address - Country:US
Mailing Address - Phone:626-308-3933
Mailing Address - Fax:
Practice Address - Street 1:1234 S GARFIELD AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5065
Practice Address - Country:US
Practice Address - Phone:626-308-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38083-01OtherDENTI-CAL