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General NPI Number Information
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NPI Number | 1427440262
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Entity Type | Organization
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Legal Business Name | LINDA Y MAKUTA DDS PC
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 5400 BALBOA BLVD SUITE 229
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City | ENCINO
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State | CA
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Zip | 91316-1502
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Country | US
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Telephone | 818-981-7375
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 BALBOA BLVD SUITE 229
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City | ENCINO
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State | CA
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Zip | 91316-1502
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Country | US
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Telephone | 818-981-7375
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LINDA Y MAKUTA
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Credential | DDS
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Telephone | 818-981-7375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 45587
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License Number State | CA
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