Provider Demographics
NPI:1902686538
Name:MAKADIA, POOJA JAYMIN (DMD)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:JAYMIN
Last Name:MAKADIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:POOJA
Other - Middle Name:SURESHBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2607 PENNOAK WAY APT E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3943
Mailing Address - Country:US
Mailing Address - Phone:929-424-1765
Mailing Address - Fax:
Practice Address - Street 1:1595 GLIDEWELL DR STE 104
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8254
Practice Address - Country:US
Practice Address - Phone:336-524-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist