Provider Demographics
NPI:1871672477
Name:MAKOWSKI, MELISSA SUE (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:MAKOWSKI
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 1:109 W HURLBUT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1309
Mailing Address - Country:US
Mailing Address - Phone:231-547-4347
Mailing Address - Fax:
Practice Address - Street 1:109 W HURLBUT ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1309
Practice Address - Country:US
Practice Address - Phone:231-547-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist