Healthcare Provider Details

I. General information

NPI: 1467846311
Provider Name (Legal Business Name): RONAK MAKADIA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29560 RANCHO CALIFORNIA RD
TEMECULA CA
92591
US

IV. Provider business mailing address

5351 E PALISADES RD
SAN DIEGO CA
92116-2047
US

V. Phone/Fax

Practice location:
  • Phone: 909-996-6951
  • Fax:
Mailing address:
  • Phone: 909-996-6951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDDS102467
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: