Provider Demographics
NPI:1396273694
Name:HOMERO A. MAK DDS, INC
Entity type:Organization
Organization Name:HOMERO A. MAK DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOMERO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-283-8889
Mailing Address - Street 1:8105 EDGEWATER DR STE 122
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-2019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8105 EDGEWATER DR STE 122
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2019
Practice Address - Country:US
Practice Address - Phone:510-283-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty