Provider Demographics
NPI:1861608713
Name:MAKHOUL, GERARD JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JAMES
Last Name:MAKHOUL
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 1:847 HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1230
Mailing Address - Country:US
Mailing Address - Phone:201-358-1125
Mailing Address - Fax:
Practice Address - Street 1:7502 13TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2410
Practice Address - Country:US
Practice Address - Phone:718-680-6515
Practice Address - Fax:718-680-6515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040237-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice