Roosevelt Field Mall Dental Pc | |
630 Old Country Road Garden City NY 11530 | |
(516) 294-1919 | |
(516) 294-6219 |
Full Name | Roosevelt Field Mall Dental Pc |
---|---|
Speciality | Dentist - Periodontics |
Location | 630 Old Country Road, Garden City, New York |
Authorized Official Name and Position | Alexander M Mikhailov (OWNER) |
Authorized Official Contact | 5162941919 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Roosevelt Field Mall Dental Pc 630 Old Country Road Garden City NY 11530 Ph: (516) 294-1919 | Roosevelt Field Mall Dental Pc 630 Old Country Road Garden City NY 11530 Ph: (516) 294-1919 |
NPI Number | 1073638151 |
---|---|
Provider Enumeration Date | 03/20/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073638151 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (New York) | Primary |
1223P0300X | Dentist - Periodontics | (New York) | Primary |
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