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General NPI Number Information
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NPI Number | 1578832754
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Entity Type | Organization
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Legal Business Name | BELLA MAKAGON DENTISTRY, PS
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 116 FAIRVIEW AVE N SUITE 148
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City | SEATTLE
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State | WA
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Zip | 98109-5360
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Country | US
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Telephone | 206-682-7942
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Fax | 206-701-7965
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Provider Business Mailing Address
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Address Line | 16681 NE 121ST WAY
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City | REDMOND
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State | WA
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Zip | 98052-1208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BELLA MAKAGON
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Credential | DMD
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Telephone | 425-516-4167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE 60058471
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License Number State | WA
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