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NPI Code Detail

MEDICARE: BARRY A. MENTZEL, D.D.S., P.C.

MEDICARE: BARRY A. MENTZEL, D.D.S., P.C.
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
11223P0300XPeriodonticsM10005MI

General Provider Information

NPI Number : 1700053634
Entity Type Code : Organization
Provider Name (Legal Business Name) : BARRY A. MENTZEL, D.D.S., P.C.
Provider Business Mailing Address
First Line : 19925 E 10 MILE RD
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48080-1069
Country : US
Telephone Number : 586-772-1880
Fax Number : 586-772-5837
Provider Business Practice Location Address
First Line : 19925 E 10 MILE RD
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48080-1069
Country : US
Telephone Number : 586-772-1880
Fax Number : 586-772-5837
Authorized Official
Title or Position : PRESIDENT
Name : DR. BARRY ALLEN MENTZEL
Credential : D.D.S.
Telephone Number : 586-772-1880
Provider Enumeration Date : 05/09/2008
Last Update Date : 05/09/2008

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