Provider Demographics
NPI:1790433001
Name:MAKAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:MAKAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-872-8681
Mailing Address - Street 1:1908 RUE LE CHARLENE
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6372
Mailing Address - Country:US
Mailing Address - Phone:310-872-8681
Mailing Address - Fax:
Practice Address - Street 1:5555 TRUXTUN AVE STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0604
Practice Address - Country:US
Practice Address - Phone:310-872-8681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty