# LIVINGSTON MALL DENTAL, PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972665057
- **Authorized official:** DR. ALEXANDER MIKHAILOV DDS (OWNER)
- **Authorized official phone:** (973) 422-9399

## Contact information

- **Practice address:** 112 EISENHOWER PKWY, LIVINGSTON, NJ 07039-4995
- **Practice address phone:** (973) 422-9399
- **Practice address fax:** (973) 422-1828
- **Mailing address:** 112 EISENHOWER PKWY, LIVINGSTON, NJ 07039-4995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 19779 | NJ | Yes |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8094705 | — | NJ |