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General NPI Number Information
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NPI Number | 1053647081
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Entity Type | Individual
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Provider Name | MIKHAIL I MUKHIN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 1415 EASTERN AVE
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City | PLYMOUTH
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State | WI
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Zip | 53073
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Country | US
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Telephone | 414-430-7286
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 EASTERN AVE
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City | PLYMOUTH
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State | WI
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Zip | 53073-2018
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Country | US
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Telephone | 209-893-8458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6383-15
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License Number State | WI
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