Provider Demographics
NPI:1538573357
Name:MIKHAIL, IRENI NADER (DMD)
Entity type:Individual
Prefix:DR
First Name:IRENI
Middle Name:NADER
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13512 S JOHN YOUNG PKWY
Mailing Address - Street 2:STE: 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7678
Mailing Address - Country:US
Mailing Address - Phone:407-857-6501
Mailing Address - Fax:
Practice Address - Street 1:13512 S JOHN YOUNG PKWY
Practice Address - Street 2:STE: 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7678
Practice Address - Country:US
Practice Address - Phone:407-857-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN211321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program