Provider Demographics
NPI:1396865705
Name:MAKOWSKI, JASON PHILLIP
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:PHILLIP
Last Name:MAKOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BRIDGES RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5700
Mailing Address - Country:US
Mailing Address - Phone:864-675-6445
Mailing Address - Fax:864-675-6447
Practice Address - Street 1:220 BRIDGES RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5700
Practice Address - Country:US
Practice Address - Phone:864-675-6445
Practice Address - Fax:864-675-6447
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 37241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice