Provider Demographics
NPI:1437224664
Name:MAKHSUDOVA DENTAL CORPORATION
Entity Type:Organization
Organization Name:MAKHSUDOVA DENTAL CORPORATION
Other - Org Name:KIDS DENTAL KARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LALA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHSUDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-461-9942
Mailing Address - Street 1:4905 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6101
Mailing Address - Country:US
Mailing Address - Phone:323-461-9942
Mailing Address - Fax:
Practice Address - Street 1:4905 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6101
Practice Address - Country:US
Practice Address - Phone:323-461-9942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG89888-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty