Provider Demographics
NPI:1740405042
Name:EARST, MAKEBA SHERRON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAKEBA
Middle Name:SHERRON
Last Name:EARST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 VINEYARD WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7913
Mailing Address - Country:US
Mailing Address - Phone:850-562-6835
Mailing Address - Fax:850-562-0470
Practice Address - Street 1:2332 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4318
Practice Address - Country:US
Practice Address - Phone:850-863-3333
Practice Address - Fax:850-386-3363
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL153941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076663100Medicaid