Provider Demographics
NPI:1134506116
Name:MARK MAKLIN DMD
Entity Type:Organization
Organization Name:MARK MAKLIN DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:MAKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-325-6991
Mailing Address - Street 1:2370 N WYATT DR STE 110
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2119
Mailing Address - Country:US
Mailing Address - Phone:520-325-6991
Mailing Address - Fax:
Practice Address - Street 1:2370 N WYATT DR STE 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2119
Practice Address - Country:US
Practice Address - Phone:520-325-6991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD2008261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1609904879Medicaid