MEDICARE: MARK MAKILING

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	058707-1	NY

General Provider Information

NPI Number	:	1629461678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MAKILING

Provider Business Mailing Address
First Line	:	8 ALEX CT
Second Line	:
City	:	WEST NYACK
State	:	NY
Zip	:	10994-1731
Country	:	US
Telephone Number	:	845-367-3136
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 21 JEROME AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453
Country	:	US
Telephone Number	:	718-943-1341
Fax Number	:	718-716-3754

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

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	07/18/2018

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