Monmouth Mall Dental, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19779 Issued in NJ

Legal business name

MONMOUTH MALL DENTAL, PA

Practice address

180 Route 35 S
Eatontown, NJ 07724-2023

Phone

(201) 626-2500

NPI assigned

Jul 17, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Alexander Mikhailov, DDS

Title

President

Phone

(201) 626-2500

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1374019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1437591567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 ROUTE 35 S",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242023",
            "telephone_number": "201-626-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 ROUTE 35 S",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242023",
            "telephone_number": "201-626-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONMOUTH MALL DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-17",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "MIKHAILOV",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-626-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "19779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Francis Mongak, LMFT
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• Monmouth Cardiology Associates, LLC
• Monmouth Chiropractic Consultants
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• Monmouth Medical Association PC
• Monmouth Pulmonary Consultants P a
• Monmouth Rejuvenation, LLC
• Monmouth Tissue Laboratory, LLC
• Nakita Moorer, LPN

• General Practice Dentistry in Eatontown, NJ
• Providers in Eatontown, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; 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.