Provider Demographics
NPI:1679736607
Name:MAKRAM, SANDRA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LYNN
Last Name:MAKRAM
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 1:300 E LONG LAKE RD STE 311
Mailing Address - Street 2:GREAT EXPRESSIONS DENTAL CENTERS
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2377
Mailing Address - Country:US
Mailing Address - Phone:248-203-1119
Mailing Address - Fax:
Practice Address - Street 1:300 E LONG LAKE RD STE 311
Practice Address - Street 2:GREAT EXPRESSIONS DENTAL CENTERS
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2377
Practice Address - Country:US
Practice Address - Phone:248-203-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 181821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry