Healthcare Provider Details

I. General information

NPI: 1699528158
Provider Name (Legal Business Name): DR. GRIGORY TOKAREV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. GREG TOKAREV

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7511 SW 108TH AVE
MIAMI FL
33173-2721
US

IV. Provider business mailing address

7511 SW 108TH AVE
MIAMI FL
33173-2721
US

V. Phone/Fax

Practice location:
  • Phone: 305-873-4601
  • Fax:
Mailing address:
  • Phone: 305-873-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.035140
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN30462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: