Healthcare Provider Details

I. General information

NPI: 1164542726
Provider Name (Legal Business Name): THERESA DAO-MAKIYAMA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 BERNAL RD STE 50
SAN JOSE CA
95119-1375
US

IV. Provider business mailing address

117 BERNAL RD STE 50
SAN JOSE CA
95119-1375
US

V. Phone/Fax

Practice location:
  • Phone: 408-226-4333
  • Fax: 408-226-4399
Mailing address:
  • Phone: 408-226-4333
  • Fax: 408-226-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: