MEDICARE: DR. GERARD JAMES MAKHOUL DMD

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	040237-1	NY

General Provider Information

NPI Number	:	1861608713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD JAMES MAKHOUL DMD

Provider Business Mailing Address
First Line	:	847 HILLSDALE AVE
Second Line	:
City	:	HILLSDALE
State	:	NJ
Zip	:	07642-1230
Country	:	US
Telephone Number	:	201-358-1125
Fax Number	:

Provider Business Practice Location Address
First Line	:	7502 13TH AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2410
Country	:	US
Telephone Number	:	718-680-6515
Fax Number	:	718-680-6515

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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