Healthcare Provider Details

I. General information

NPI: 1679582761
Provider Name (Legal Business Name): MIKHAIL Y PROKOPETS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 CORNERSTONE BLVD STE 100
DAYTONA BEACH FL
32117-7144
US

IV. Provider business mailing address

28260 N TATUM BLVD STE. A-2
CAVE CREEK AZ
85331-2362
US

V. Phone/Fax

Practice location:
  • Phone: 386-251-9475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN30877
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4847
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: