Provider Demographics
NPI:1528230281
Name:LYAKHOVETSKIY, MIKHAIL
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:LYAKHOVETSKIY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 N KINGS HWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1910
Mailing Address - Country:US
Mailing Address - Phone:856-779-6379
Mailing Address - Fax:
Practice Address - Street 1:1060 N KINGS HWY
Practice Address - Street 2:SUITE 113
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1910
Practice Address - Country:US
Practice Address - Phone:856-779-6379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI203251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice