Provider Demographics
NPI:1326202615
Name:MAKADIA, PRASHANT P (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:P
Last Name:MAKADIA
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 1:417 SW SEDGWICK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367
Mailing Address - Country:US
Mailing Address - Phone:360-471-1761
Mailing Address - Fax:360-329-6121
Practice Address - Street 1:417 SW SEDGWICK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367
Practice Address - Country:US
Practice Address - Phone:360-329-4657
Practice Address - Fax:360-329-6121
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60022736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist