Provider Demographics
NPI:1598177685
Name:KAMLESH R MAKWANA DDS, P.C,
Entity Type:Organization
Organization Name:KAMLESH R MAKWANA DDS, P.C,
Other - Org Name:KLASSIK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMLESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAKWANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-724-9700
Mailing Address - Street 1:3208 N HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1646
Mailing Address - Country:US
Mailing Address - Phone:314-799-9470
Mailing Address - Fax:314-837-4716
Practice Address - Street 1:3208 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1646
Practice Address - Country:US
Practice Address - Phone:314-799-9470
Practice Address - Fax:314-837-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty