Provider Demographics
NPI:1356613608
Name:PARUL DUA MAKKAR DDS, PC
Entity type:Organization
Organization Name:PARUL DUA MAKKAR DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARUL
Authorized Official - Middle Name:DUA
Authorized Official - Last Name:MAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-641-1160
Mailing Address - Street 1:121-02 LIBERTY AVENUE
Mailing Address - Street 2:
Mailing Address - City:S. RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2112
Mailing Address - Country:US
Mailing Address - Phone:718-641-1160
Mailing Address - Fax:718-641-1167
Practice Address - Street 1:121-02 LIBERTY AVENUE
Practice Address - Street 2:
Practice Address - City:S. RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2112
Practice Address - Country:US
Practice Address - Phone:718-641-1160
Practice Address - Fax:718-641-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02966310Medicaid