Provider Demographics
NPI:1245931971
Name:MICHAIL, ABDALLAH
Entity type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:
Last Name:MICHAIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 DRYDEN RD APT 300
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8738
Mailing Address - Country:US
Mailing Address - Phone:845-240-4931
Mailing Address - Fax:
Practice Address - Street 1:2 GRAHAM RD W
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1055
Practice Address - Country:US
Practice Address - Phone:607-319-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2025-07-21
Deactivation Date:2023-03-10
Deactivation Code:
Reactivation Date:2023-04-12
Provider Licenses
StateLicense IDTaxonomies
NY0647411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics