Provider Demographics
NPI:1396338752
Name:MAKEYEVA SUH, KARINA ANDREEVNA (RDH)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:ANDREEVNA
Last Name:MAKEYEVA SUH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 467 BOX 3206
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096-0033
Mailing Address - Country:US
Mailing Address - Phone:360-515-1571
Mailing Address - Fax:
Practice Address - Street 1:HEERSTRASSE 19 FLUGPLATZ ERBENHEIM
Practice Address - Street 2:
Practice Address - City:WIESBADEN
Practice Address - State:HESSEN
Practice Address - Zip Code:65205
Practice Address - Country:DE
Practice Address - Phone:360-515-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10970124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist