Provider Demographics
NPI:1164542726
Name:DAO-MAKIYAMA, THERESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:DAO-MAKIYAMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BERNAL RD STE 50
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1375
Mailing Address - Country:US
Mailing Address - Phone:408-226-4333
Mailing Address - Fax:408-226-4399
Practice Address - Street 1:117 BERNAL RD STE 50
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1375
Practice Address - Country:US
Practice Address - Phone:408-226-4333
Practice Address - Fax:408-226-4399
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist