Provider Demographics
NPI:1619044823
Name:MAKATI, SHABBIR (DDS)
Entity Type:Individual
Prefix:
First Name:SHABBIR
Middle Name:
Last Name:MAKATI
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 1:308 N LA CADENA DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2946
Mailing Address - Country:US
Mailing Address - Phone:609-742-7836
Mailing Address - Fax:717-397-8881
Practice Address - Street 1:308 N LA CADENA DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2946
Practice Address - Country:US
Practice Address - Phone:609-742-7836
Practice Address - Fax:717-397-8881
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9183504OtherDORAL DENTAL
PA101582421Medicaid
PA000000180471OtherUNISON