Provider Demographics
NPI:1548479066
Name:MAKUTA, LINDA Y (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:Y
Last Name:MAKUTA
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 1:20224 KINZIE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5432
Mailing Address - Country:US
Mailing Address - Phone:949-677-1492
Mailing Address - Fax:
Practice Address - Street 1:20224 KINZIE ST
Practice Address - Street 2:SUITE #100
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-5432
Practice Address - Country:US
Practice Address - Phone:949-677-1492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist