Provider Demographics
NPI:1942423561
Name:MAKINS, PATRICK CLARENCE (DDS MSD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:CLARENCE
Last Name:MAKINS
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904
Mailing Address - Country:US
Mailing Address - Phone:325-949-9505
Mailing Address - Fax:325-944-8106
Practice Address - Street 1:3010 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904
Practice Address - Country:US
Practice Address - Phone:325-949-9505
Practice Address - Fax:325-944-8106
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
T14558Medicare UPIN
D11329Medicare ID - Type Unspecified