Provider Demographics
NPI:1447878988
Name:MIKHAIL, ANDREW KIROLLOS (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KIROLLOS
Last Name:MIKHAIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1932
Mailing Address - Country:US
Mailing Address - Phone:626-348-1604
Mailing Address - Fax:
Practice Address - Street 1:923 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2420
Practice Address - Country:US
Practice Address - Phone:909-592-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1049731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice