Provider Demographics
NPI:1508053216
Name:MAKONAHALLY, DEVIPRASAD M (BDS MSC)
Entity Type:Individual
Prefix:
First Name:DEVIPRASAD
Middle Name:M
Last Name:MAKONAHALLY
Suffix:
Gender:M
Credentials:BDS MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01050-9777
Mailing Address - Country:US
Mailing Address - Phone:413-667-3009
Mailing Address - Fax:413-667-8746
Practice Address - Street 1:73 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:MA
Practice Address - Zip Code:01050-9777
Practice Address - Country:US
Practice Address - Phone:413-667-3009
Practice Address - Fax:413-667-8746
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist