Provider Demographics
NPI:1508351933
Name:MIKHAIL, PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:MIKHAIL
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 1:31 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4116
Mailing Address - Country:US
Mailing Address - Phone:551-655-1511
Mailing Address - Fax:
Practice Address - Street 1:2770 HOOPER AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4160
Practice Address - Country:US
Practice Address - Phone:732-965-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027198001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice