=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417104571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEX KIRIL MIHAILOFF D.D.S., M.S.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2008
-----------------------------------------------------
Last Update Date | 08/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9200 MONTGOMERY RD STE 22A
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-793-6500
-----------------------------------------------------
Fax | 513-793-0905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9200 MONTGOMERY RD STE 22A
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-793-6500
-----------------------------------------------------
Fax | 513-793-0905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 20376
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 673
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------