Provider Demographics
NPI:1568804110
Name:MAK DDS INC KLEIGER DDS INC DEMESA DDS INC
Entity Type:Organization
Organization Name:MAK DDS INC KLEIGER DDS INC DEMESA DDS INC
Other - Org Name:MKD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-550-2697
Mailing Address - Street 1:523 W 6TH ST STE 515
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-1225
Mailing Address - Country:US
Mailing Address - Phone:213-550-2697
Mailing Address - Fax:
Practice Address - Street 1:523 W 6TH ST STE 515
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-1225
Practice Address - Country:US
Practice Address - Phone:213-550-2697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002681875-001-21223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty