Provider Demographics
NPI:1598937146
Name:MAKWANA, KAMLESH R (DDS)
Entity Type:Individual
Prefix:
First Name:KAMLESH
Middle Name:R
Last Name:MAKWANA
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 1:10433 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2342
Mailing Address - Country:US
Mailing Address - Phone:314-524-3000
Mailing Address - Fax:314-524-5020
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE015863122300000X
IL019.027568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist