Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901022393 | MI |
NPI | 1003338740 |
---|---|
Provider Name | Mikhail Arkhipov |
First Address | Brooklyn, NY 11235-6912 |
Second Address | Detroit, MI 48208-2576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2017 |
Last Update Date | 14/07/2017 |