Provider Demographics
NPI:1114112935
Name:GANKIN, MIKHAIL M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:M
Last Name:GANKIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 N FRANKLIN ST
Mailing Address - Street 2:2801
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3859
Mailing Address - Country:US
Mailing Address - Phone:323-868-6670
Mailing Address - Fax:
Practice Address - Street 1:808 N FRANKLIN ST
Practice Address - Street 2:#2801
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3859
Practice Address - Country:US
Practice Address - Phone:323-868-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN205501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics