=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982214276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GURBANI K MAKKAR DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2020
-----------------------------------------------------
Last Update Date | 08/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5848 ABRAMS RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75214-1603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-545-0111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3241 LOYOLA DR
-----------------------------------------------------
City | FLOWER MOUND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75022-4976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-993-9800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 36447
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------