MEDICARE: DR. WASEEM NIDAL MAKKI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901021913	MI

General Provider Information

NPI Number	:	1023466174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WASEEM NIDAL MAKKI D.D.S.

Provider Business Mailing Address
First Line	:	6440 OAKMAN BLVD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2314
Country	:	US
Telephone Number	:	313-433-7877
Fax Number	:

Provider Business Practice Location Address
First Line	:	3257 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-3632
Country	:	US
Telephone Number	:	313-383-2270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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