Healthcare Provider Details

I. General information

NPI: 1508073818
Provider Name (Legal Business Name): MELVIN MIZNER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ESSEX GREEN DR SUITE 54
PEABODY MA
01960-2961
US

IV. Provider business mailing address

52 VALIANT WAY
SALEM MA
01970-6613
US

V. Phone/Fax

Practice location:
  • Phone: 978-535-8244
  • Fax: 978-535-8240
Mailing address:
  • Phone: 978-535-8244
  • Fax: 978-535-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8743
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: