Provider Demographics
NPI:1528686862
Name:MAKI, LEILA (DMD)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:MAKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 FIELDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-6862
Mailing Address - Country:US
Mailing Address - Phone:484-844-9204
Mailing Address - Fax:
Practice Address - Street 1:8355 LORETTO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1853
Practice Address - Country:US
Practice Address - Phone:215-342-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist