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Organization
ROOSEVELT FIELD MALL DENTAL PC
Active
Organization
ROOSEVELT FIELD MALL DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER M MIKHAILOV DDS (OWNER)
(516) 294-1919
Entity
Organization
Contact information
Practice address
630 OLD COUNTRY ROAD, GARDEN CITY, NY 11530
(516) 294-1919
(516) 294-6219
Mailing address
630 OLD COUNTRY ROAD, GARDEN CITY, NY 11530
(516) 294-1919
(516) 294-6219
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
NY
1223P0300X
Periodontics
Primary
—
NY
Other
Enumeration date
03/20/2007
Last updated
09/11/2025
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