Provider Demographics
NPI:1730740325
Name:MAK, RONALD J (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:MAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1014
Mailing Address - Country:US
Mailing Address - Phone:650-455-9528
Mailing Address - Fax:
Practice Address - Street 1:2996 S NORFOLK ST STE E
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2076
Practice Address - Country:US
Practice Address - Phone:650-349-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103808122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist