Provider Demographics
NPI:1679958532
Name:POUGH, MAKEEBA BOOKHART (DMD)
Entity Type:Individual
Prefix:
First Name:MAKEEBA
Middle Name:BOOKHART
Last Name:POUGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1846
Mailing Address - Country:US
Mailing Address - Phone:803-252-8101
Mailing Address - Fax:
Practice Address - Street 1:3126 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1846
Practice Address - Country:US
Practice Address - Phone:803-252-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice