Provider Demographics
NPI:1679582761
Name:PROKOPETS, MIKHAIL Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:Y
Last Name:PROKOPETS
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 1:28260 N TATUM BLVD
Mailing Address - Street 2:STE. A-2
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-2362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28260 N TATUM BLVD
Practice Address - Street 2:STE. A-2
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-2362
Practice Address - Country:US
Practice Address - Phone:480-515-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice