=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144328972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARKHAM FAMILY DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8961 HEIL AVE
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-847-2232
-----------------------------------------------------
Fax | 714-841-2883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8961 HEIL AVE
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-847-2232
-----------------------------------------------------
Fax | 714-841-2883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DON C MARKHAM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 714-847-2232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 25007
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 27030
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------