Provider Demographics
NPI:1821386285
Name:MAKAN, SIRISH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIRISH
Middle Name:
Last Name:MAKAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1809
Mailing Address - Country:US
Mailing Address - Phone:310-872-8681
Mailing Address - Fax:
Practice Address - Street 1:123 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1809
Practice Address - Country:US
Practice Address - Phone:310-872-8681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9353122300000X
CA653051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist