Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DM0009883 | FL |
NPI | 1144396953 |
---|---|
Provider Name | Mr. Mongi Gadall Mikhail |
First Address | Boca Raton, FL 33486 |
Second Address | Boca Raton, FL 33486 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 26/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DM0009883 | (02) |