| 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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