Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN20550 | FL |
NPI | 1114112935 |
---|---|
Provider Name | Dr. Mikhail M Gankin |
First Address | Tampa, FL 33602-3859 |
Second Address | Tampa, FL 33602-3859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2007 |
Last Update Date | 22/07/2014 |