Healthcare Provider Details

I. General information

NPI: 1376701268
Provider Name (Legal Business Name): NINA MIHAYCHUK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA BOYKO MIHAYCHUK DMD

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 09/01/2024
Certification Date: 09/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13975 CONNECTICUT AVE SUITE 208
SILVER SPRING MD
20906-2921
US

IV. Provider business mailing address

15429 JOHNSON RD
SILVER SPRING MD
20905-3869
US

V. Phone/Fax

Practice location:
  • Phone: 301-598-3951
  • Fax: 301-603-0861
Mailing address:
  • Phone: 301-879-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10749
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: