Provider Demographics
NPI:1588825715
Name:MIKHAILOV, RAFAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:MIKHAILOV
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 1:65 JEFFERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201
Mailing Address - Country:US
Mailing Address - Phone:908-527-8688
Mailing Address - Fax:908-527-9399
Practice Address - Street 1:65 JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201
Practice Address - Country:US
Practice Address - Phone:908-527-8688
Practice Address - Fax:908-527-9399
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102237900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ026492Medicaid