Healthcare Provider Details

I. General information

NPI: 1598863656
Provider Name (Legal Business Name): MICHAEL L MAKI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17425 VASHON HWY SW SUITE #3
VASHON WA
98070
US

IV. Provider business mailing address

PO BOX 673
VASHON WA
98070-0673
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-9282
  • Fax: 206-463-6343
Mailing address:
  • Phone: 206-463-9282
  • Fax: 206-463-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4729
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: