Provider Demographics
NPI:1265716252
Name:MIKHAIL DENTAL SERVICES, PLLC
Entity type:Organization
Organization Name:MIKHAIL DENTAL SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-455-0466
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-08
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty