Provider Demographics
NPI:1578761193
Name:DOHR, MAK NAI (HYGIENIST)
Entity Type:Individual
Prefix:
First Name:MAK
Middle Name:NAI
Last Name:DOHR
Suffix:
Gender:F
Credentials:HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5202
Mailing Address - Country:US
Mailing Address - Phone:951-276-0668
Mailing Address - Fax:951-328-9578
Practice Address - Street 1:1970 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5202
Practice Address - Country:US
Practice Address - Phone:951-276-0668
Practice Address - Fax:951-328-9578
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH15208124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG98054-04OtherDELTA DENTAL
CAG98054-02OtherDELTA DENTAL
CAFHC70865FOtherMEDICAL