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NPI Code Detail

MEDICARE: BELLA MAKAGON DENTISTRY, PS

MEDICARE: BELLA MAKAGON DENTISTRY, PS
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
1122300000XDentistDE 60058471WA

General Provider Information

NPI Number : 1578832754
Entity Type Code : Organization
Provider Name (Legal Business Name) : BELLA MAKAGON DENTISTRY, PS
Provider Business Mailing Address
First Line : 16681 NE 121ST WAY
Second Line :
City : REDMOND
State : WA
Zip : 98052-1208
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 116 FAIRVIEW AVE N
Second Line : SUITE 148
City : SEATTLE
State : WA
Zip : 98109-5360
Country : US
Telephone Number : 206-682-7942
Fax Number : 206-701-7965
Authorized Official
Title or Position : PRESIDENT
Name : DR. BELLA MAKAGON
Credential : DMD
Telephone Number : 425-516-4167
Provider Enumeration Date : 12/19/2011
Last Update Date : 12/19/2011

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