Provider Demographics
NPI:1205907292
Name:MAKHOUL, JOHN F (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:MAKHOUL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1200 E RIDGEWOOD AV
Mailing Address - Street 2:2ND FLOOR WESR WING
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-444-9011
Mailing Address - Fax:201-857-4676
Practice Address - Street 1:1200 E RIDGEWOOD AV
Practice Address - Street 2:2ND FLOOR WEST WING
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-444-9011
Practice Address - Fax:201-857-4676
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ106521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice