Provider Demographics
NPI:1770888414
Name:MAKHANI, ERUM (DDS)
Entity type:Individual
Prefix:
First Name:ERUM
Middle Name:
Last Name:MAKHANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 PALO VERDE CMNS
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5881
Mailing Address - Country:US
Mailing Address - Phone:408-391-0390
Mailing Address - Fax:
Practice Address - Street 1:1150 SCOTT BLVD
Practice Address - Street 2:SUITE A2
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4547
Practice Address - Country:US
Practice Address - Phone:408-985-7933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587401223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist