MEDICARE: DR. CRAIG STANLEY MAKISHIMA DDS

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	033627	CA

General Provider Information

NPI Number	:	1982779146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG STANLEY MAKISHIMA DDS

Provider Business Mailing Address
First Line	:	930 FLORIN RD
Second Line	:	SUITE 201
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-5001
Country	:	US
Telephone Number	:	916-422-2722
Fax Number	:	916-422-0351

Provider Business Practice Location Address
First Line	:	1355 FLORIN ROAD
Second Line	:	SUITE 4
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4231
Country	:	US
Telephone Number	:	916-422-2722
Fax Number	:	916-422-0351

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	04/26/2012

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