Provider Demographics
NPI:1295725661
Name:MAKKAR, LAKSHMI C (DDS)
Entity type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:C
Last Name:MAKKAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 120TH ST
Mailing Address - Street 2:#1
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2812
Mailing Address - Country:US
Mailing Address - Phone:718-641-1160
Mailing Address - Fax:
Practice Address - Street 1:10402 120TH ST
Practice Address - Street 2:#1
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2812
Practice Address - Country:US
Practice Address - Phone:718-641-1160
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039733122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01029010Medicaid