MEDICARE: MICHAEL MEARS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	064926	NY

General Provider Information

NPI Number	:	1568159044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MEARS DMD

Provider Business Mailing Address
First Line	:	3505 PARKCREST DR
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-8611
Country	:	US
Telephone Number	:	209-551-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	6321 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2941
Country	:	US
Telephone Number	:	209-551-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	09/07/2025

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