Provider Demographics
NPI:1144396953
Name:MIKHAIL, MONGI GADALL (DDS)
Entity Type:Individual
Prefix:MR
First Name:MONGI
Middle Name:GADALL
Last Name:MIKHAIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 NW 10TH AVE #401
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-394-9911
Mailing Address - Fax:561-394-9915
Practice Address - Street 1:1590 NW 10TH AVE #401
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-394-9911
Practice Address - Fax:561-394-9915
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDM00098831223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
60781Medicare ID - Type Unspecified
DM0009883Medicare UPIN