Provider Demographics
NPI:1376672980
Name:MAK, GILBERT K (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:K
Last Name:MAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 661059
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1059
Mailing Address - Country:US
Mailing Address - Phone:626-308-3933
Mailing Address - Fax:626-282-3119
Practice Address - Street 1:1234 S GARFIELD AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5065
Practice Address - Country:US
Practice Address - Phone:626-308-3933
Practice Address - Fax:626-282-3119
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA380831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38083-1OtherMEDICAL