| NPI | 1073638151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER M MIKHAILOV Owner 516-294-1919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-08-22 |