Provider Demographics
NPI:1447466529
Name:EM MAKHOUL DDS, INC.
Entity type:Organization
Organization Name:EM MAKHOUL DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-364-3724
Mailing Address - Street 1:27871 MEDICAL CENTER RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6404
Mailing Address - Country:US
Mailing Address - Phone:949-364-3724
Mailing Address - Fax:949-364-0729
Practice Address - Street 1:27871 MEDICAL CENTER RD
Practice Address - Street 2:SUITE #105
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6404
Practice Address - Country:US
Practice Address - Phone:949-364-3724
Practice Address - Fax:949-364-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADY0319481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty