Provider Demographics
NPI:1083800049
Name:MAKAGON, BELLA (DMD)
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:MAKAGON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 FAIRVIEW AVE N
Mailing Address - Street 2:SUITE 148
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5360
Mailing Address - Country:US
Mailing Address - Phone:206-682-7942
Mailing Address - Fax:206-701-7965
Practice Address - Street 1:116 FAIRVIEW AVE N
Practice Address - Street 2:SUITE 148
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5360
Practice Address - Country:US
Practice Address - Phone:206-682-7942
Practice Address - Fax:206-701-7965
Is Sole Proprietor?:No
Enumeration Date:2007-09-23
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600584711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice