Provider Demographics
NPI:1730109943
Name:PLANKEN, MACARENA (DDS)
Entity type:Individual
Prefix:MRS
First Name:MACARENA
Middle Name:
Last Name:PLANKEN
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 1:3401 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4343
Mailing Address - Country:US
Mailing Address - Phone:516-679-9444
Mailing Address - Fax:516-679-0855
Practice Address - Street 1:3401 MERRICK RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4343
Practice Address - Country:US
Practice Address - Phone:516-679-9444
Practice Address - Fax:516-679-0855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02419749Medicaid