Healthcare Provider Details

I. General information

NPI: 1538245519
Provider Name (Legal Business Name): HANY M MAKKAWY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40TH & HOLDREGE STREETS COLLEGE OF DENTISTRY
LINCOLN NE
68583-0740
US

IV. Provider business mailing address

1900 DEVOE DR
LINCOLN NE
68506-1865
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1317
  • Fax: 402-472-5290
Mailing address:
  • Phone: 402-472-1317
  • Fax: 402-472-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5726
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: