Healthcare Provider Details

I. General information

NPI: 1902537673
Provider Name (Legal Business Name): MELISSA KAREN KRIZNER-MEZA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SW MAIN BLVD
LAKE CITY FL
32025-7050
US

IV. Provider business mailing address

4643 SW 44TH LN
GAINESVILLE FL
32608-4937
US

V. Phone/Fax

Practice location:
  • Phone: 386-752-2480
  • Fax:
Mailing address:
  • Phone: 954-319-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: