Organization
LIVINGSTON MALL DENTAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER MIKHAILOV DDS (OWNER)
(973) 422-9399
Entity
Organization
Contact information
Practice address
112 EISENHOWER PKWY, LIVINGSTON, NJ 07039-4995
(973) 422-9399
(973) 422-1828
Mailing address
112 EISENHOWER PKWY, LIVINGSTON, NJ 07039-4995
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19779
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8094705
—
NJ
Enumeration date
12/14/2006
Last updated
08/22/2020
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