Provider Demographics
NPI:1669666145
Name:MIKHAIL, RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
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 1:1602 VILLAGE MARKET BLVD SE
Mailing Address - Street 2:SUITE #130
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4669
Mailing Address - Country:US
Mailing Address - Phone:571-455-0466
Mailing Address - Fax:
Practice Address - Street 1:1602 VILLAGE MARKET BLVD SE
Practice Address - Street 2:SUITE #130
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4669
Practice Address - Country:US
Practice Address - Phone:571-455-0466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist