Provider Demographics
NPI:1336778638
Name:BABAYAN, MIKHAIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:BABAYAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 AMBOY RD APT 1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3138
Mailing Address - Country:US
Mailing Address - Phone:917-742-9952
Mailing Address - Fax:
Practice Address - Street 1:3987 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5112
Practice Address - Country:US
Practice Address - Phone:718-776-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063430-011223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics