Healthcare Provider Details

I. General information

NPI: 1033790621
Provider Name (Legal Business Name): MISHEL YOSHUVA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MAIN ST
BRIDGEPORT CT
06604-4221
US

IV. Provider business mailing address

7325 173RD ST
FRESH MEADOWS NY
11366-1429
US

V. Phone/Fax

Practice location:
  • Phone: 203-367-0400
  • Fax:
Mailing address:
  • Phone: 917-400-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number062845-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number13519
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: