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ROOSEVELT FIELD MALL DENTAL PC
NPI 1073638151
Dentist - Periodontics in Garden City, NY

Active since March 20, 2007
630 OLD COUNTRY ROAD, GARDEN CITY, NY 11530(516) 294-1919(516) 294-6219 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 11, 2025, Aug 22, 2020 (2 updates tracked since 2020).

About Roosevelt Field Mall Dental Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROOSEVELT FIELD MALL DENTAL PC (NPI 1073638151) is a healthcare organization registered as a periodontics in Garden City, New York and active in the NPI registry since March 2007. The organization lists Alexander M Mikhailov, Owner, as its authorized official.

NPPES Registry Identity

NPI1073638151
Entity TypeOrganization
Primary Taxonomy1223P0300X
Legal Business NameROOSEVELT FIELD MALL DENTAL PC
Location Address630 OLD COUNTRY ROADGarden City, NY 11530
Mailing Address630 Old Country RoadGarden City, NY 11530 · (516) 294-1919 · Fax (516) 294-6219
Phone(516) 294-1919
Fax(516) 294-6219
Organization SubpartNo
Authorized OfficialAlexander M MikhailovOwner · (516) 294-1919
Enumeration DateMarch 20, 2007
Last NPPES UpdateSeptember 11, 20252 updates tracked since enumeration
✔ NPI 1073638151 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
Also ListedDentist · General PracticeTaxonomy 1223G0001X
630 OLD COUNTRY ROAD, Garden City, NY 11530
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Roosevelt Field Mall Dental PC's NPI number?

The NPI number for Roosevelt Field Mall Dental PC is 1073638151. It was assigned to this organization in the NPPES registry on March 20, 2007.

Where is Roosevelt Field Mall Dental PC located?

Roosevelt Field Mall Dental PC is located at 630 Old Country Road, Garden City, NY 11530. The listed phone number is (516) 294-1919.

What is Roosevelt Field Mall Dental PC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

What insurance does Roosevelt Field Mall Dental PC accept?

Health plans from UnitedHealthcare list Roosevelt Field Mall Dental PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Roosevelt Field Mall Dental PC was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.