Provider Demographics
NPI:1275741688
Name:MAKHENE-DELOACH, MOTSHABI MAMOTSUMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOTSHABI
Middle Name:MAMOTSUMI
Last Name:MAKHENE-DELOACH
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 1:6710 OXON HILL RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1121
Mailing Address - Country:US
Mailing Address - Phone:301-839-8004
Mailing Address - Fax:301-839-8077
Practice Address - Street 1:6710 OXON HILL RD
Practice Address - Street 2:SUITE 360
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1121
Practice Address - Country:US
Practice Address - Phone:301-839-8004
Practice Address - Fax:301-839-8077
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist