Provider Demographics
NPI:1033281274
Name:MAKRAM, MARK M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:MAKRAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 MEDICAL BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1426
Mailing Address - Country:US
Mailing Address - Phone:239-513-9990
Mailing Address - Fax:239-594-9996
Practice Address - Street 1:1726 MEDICAL BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1426
Practice Address - Country:US
Practice Address - Phone:239-513-9990
Practice Address - Fax:239-594-9996
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist