Provider Demographics
NPI: | 1518130574 |
---|---|
Name: | MARY HANNA MAKHLOUF DMD MS PA |
Entity Type: | Organization |
Organization Name: | MARY HANNA MAKHLOUF DMD MS PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARY |
Authorized Official - Middle Name: | H |
Authorized Official - Last Name: | MAKHLOUF |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD,MS,PA |
Authorized Official - Phone: | 336-226-8406 |
Mailing Address - Street 1: | 1682 WESTBROOK AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | BURLINGTON |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27215-9700 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 336-226-8406 |
Mailing Address - Fax: | 336-226-9281 |
Practice Address - Street 1: | 1682 WESTBROOK AVE |
Practice Address - Street 2: | |
Practice Address - City: | BURLINGTON |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27215-9700 |
Practice Address - Country: | US |
Practice Address - Phone: | 336-226-8406 |
Practice Address - Fax: | 336-226-9281 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-04-10 |
Last Update Date: | 2015-07-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 5767 | 261QD0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |