Provider Demographics
NPI:1598863656
Name:MAKI, MICHAEL L (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:MAKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-0673
Mailing Address - Country:US
Mailing Address - Phone:206-463-9282
Mailing Address - Fax:206-463-6343
Practice Address - Street 1:17425 VASHON HWY SW
Practice Address - Street 2:SUITE #3
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070
Practice Address - Country:US
Practice Address - Phone:206-463-9282
Practice Address - Fax:206-463-6343
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA47291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA53992808Medicaid