Provider Demographics
NPI:1952534661
Name:MAK, VICTOR W (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:W
Last Name:MAK
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 1:3628 MERIDIAN ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1735
Mailing Address - Country:US
Mailing Address - Phone:360-671-5500
Mailing Address - Fax:360-738-8464
Practice Address - Street 1:3628 MERIDIAN ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1735
Practice Address - Country:US
Practice Address - Phone:360-671-5500
Practice Address - Fax:360-738-8464
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00110941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics