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General NPI Number Information
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NPI Number | 1942723358
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Entity Type | Individual
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Provider Name | MIKHAIL PALKHOUSKI DMD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 6776 MARKET ST
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City | UPPER DARBY
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State | PA
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Zip | 19082-2432
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Country | US
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Telephone | 610-734-0115
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Fax |
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Provider Business Mailing Address
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Address Line | 506 S 41 ST APT. 1D
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 347-988-6809
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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 | DS041354
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License Number State | PA
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