MEDICARE: DR. AVRAHAM MIZRACHI DDS

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	1223G0001X	General Practice Dentistry	11762	MD

General Provider Information

NPI Number	:	1780733014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVRAHAM MIZRACHI DDS

Provider Business Mailing Address
First Line	:	7274 CRADLEROCK WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5069
Country	:	US
Telephone Number	:	410-381-0505
Fax Number	:	410-381-0902

Provider Business Practice Location Address
First Line	:	7274 CRADLEROCK WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5069
Country	:	US
Telephone Number	:	410-381-0505
Fax Number	:	410-381-0902

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	01/31/2013

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