Provider Demographics
NPI:1073184180
Name:GUL, MISHA
Entity type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:GUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 LINTON BLVD STE 8A
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6501
Mailing Address - Country:US
Mailing Address - Phone:804-497-9872
Mailing Address - Fax:
Practice Address - Street 1:4801 LINTON BLVD STE 8A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6501
Practice Address - Country:US
Practice Address - Phone:804-497-9872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist