Provider Demographics
NPI:1922211200
Name:MACKS, ALAN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:F
Last Name:MACKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 TACOMA MALL BLVD.
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409
Mailing Address - Country:US
Mailing Address - Phone:253-476-1030
Mailing Address - Fax:253-476-1031
Practice Address - Street 1:5319 TACOMA MALL BLVD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7072
Practice Address - Country:US
Practice Address - Phone:253-476-1030
Practice Address - Fax:253-476-1031
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist