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General NPI Number Information
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NPI Number | 1285810036
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Entity Type | Organization
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Legal Business Name | DR. MAK DENTAL CORP.
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 1234 S GARFIELD AVE SUITE 108
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City | ALHAMBRA
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State | CA
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Zip | 91801-5065
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Country | US
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Telephone | 626-308-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 S GARFIELD AVE SUITE 108
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City | ALHAMBRA
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State | CA
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Zip | 91801-5065
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Country | US
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Telephone | 626-308-3933
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GILBERT K MAK
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Credential | DDS
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Telephone | 626-308-3933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 38083
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License Number State | CA
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