Livingston Mall Dental, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19779 Issued in NJ

Legal business name

LIVINGSTON MALL DENTAL, PA

Practice address

112 Eisenhower Pkwy
Livingston, NJ 07039-4995

Phone

(973) 422-9399

Fax

(973) 422-1828

NPI assigned

Dec 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

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

Owner

Phone

(973) 422-9399

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972665057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 EISENHOWER PKWY",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 EISENHOWER PKWY",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394995",
            "telephone_number": "973-422-9399",
            "fax_number": "973-422-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVINGSTON MALL DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MIKHAILOV",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-422-9399",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8094705",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Livingston Endodontic Associates, P.a.
• Livingston Eye Associates,L.L.C.
• Livingston Family Eyecare Inc.
• Livingston Healthcare, LLC
• Livingston Hospital Physicians, P.a.
• Livingston Medical Associates PA
• Livingston Orthopaedic Group, PA
• Livingston Pathology Associates, LLC
• Livingston Periodontal Associates, LLC
• Livingston Post Acute Operator LLC

• General Practice Dentistry in Livingston, NJ
• Providers in Livingston, 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 Aug 22, 2020; 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.