Roosevelt Field Mall Dental PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

ROOSEVELT FIELD MALL DENTAL PC

Practice address

630 Old Country Road
Garden City, NY 11530

Phone

(516) 294-1919

Fax

(516) 294-6219

NPI assigned

Mar 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alexander M Mikhailov, DDS

Title

Owner

Phone

(516) 294-1919

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1073638151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 OLD COUNTRY ROAD",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "11530",
            "telephone_number": "516-294-1919",
            "fax_number": "516-294-6219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 OLD COUNTRY ROAD",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "11530",
            "telephone_number": "516-294-1919",
            "fax_number": "516-294-6219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOSEVELT FIELD MALL DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MIKHAILOV",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-294-1919",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chaya E Rokach, DPT
• Ronald Giardelli MD PC
• Ronald Young MD PC
• Roosevelt Field Hearing Aid Center Inc
• Roosevelt Field Hearing Corporation
• Roosevelt Field Vision Express, LLC
• Root and Renew Therapy LCSW PLLC
• Ashley Marie Rosado, M.S. ED, BCBA
• Danielle Nicole Rosario, ATC
• Eileen Rose

• Periodontics in Garden City, NY
• Providers in Garden City, NY by specialty
• Periodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.