Provider Demographics
NPI:1629461678
Name:MAKILING, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MAKILING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ALEX CT
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1731
Mailing Address - Country:US
Mailing Address - Phone:845-367-3136
Mailing Address - Fax:
Practice Address - Street 1:1911 21 JEROME AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-943-1341
Practice Address - Fax:718-716-3754
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058707-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice