Provider Demographics
NPI:1083191449
Name:DRAKE ROAD DENTAL PAUL MIKHLI DDS INC
Entity Type:Organization
Organization Name:DRAKE ROAD DENTAL PAUL MIKHLI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-831-5661
Mailing Address - Street 1:17601 W 130TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-5966
Mailing Address - Country:US
Mailing Address - Phone:440-582-0550
Mailing Address - Fax:
Practice Address - Street 1:17601 W 130TH ST STE 1
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133
Practice Address - Country:US
Practice Address - Phone:440-582-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL MIKHLI DDS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherDENTAL INSURANCES