Provider Demographics
NPI:1417260134
Name:MICHAEL L. MAKI, DDS
Entity Type:Organization
Organization Name:MICHAEL L. MAKI, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-463-9282
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-0673
Mailing Address - Country:US
Mailing Address - Phone:206-463-9282
Mailing Address - Fax:
Practice Address - Street 1:17425 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4653
Practice Address - Country:US
Practice Address - Phone:206-463-9282
Practice Address - Fax:206-463-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000047291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5392808Medicaid