Provider Demographics
NPI:1740448869
Name:TSOU, MAKI ISHII (DMD)
Entity type:Individual
Prefix:DR
First Name:MAKI
Middle Name:ISHII
Last Name:TSOU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:919 CONESTOGA RD
Mailing Address - Street 2:BUILDING 2, SUITE 209
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:484-380-2143
Mailing Address - Fax:484-380-2149
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BUILDING 2, SUITE 209
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:484-380-2143
Practice Address - Fax:484-380-2149
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS0367851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics