Provider Demographics
NPI:1750442679
Name:LEE, MAKULA NUWO
Entity Type:Individual
Prefix:MRS
First Name:MAKULA
Middle Name:NUWO
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAKULA
Other - Middle Name:MUWO
Other - Last Name:SIRLEAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13706 W BELL RD
Mailing Address - Street 2:STE 2
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-584-9910
Mailing Address - Fax:623-584-9940
Practice Address - Street 1:13706 W BELL RD
Practice Address - Street 2:STE 2
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-584-9910
Practice Address - Fax:623-584-9940
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant