Healthcare Provider Details

I. General information

NPI: 1003827916
Provider Name (Legal Business Name): RONALD DAVID MIZRAHI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 AVENUE U 2ND FLOOR
BROOKLYN NY
11223-4033
US

IV. Provider business mailing address

372 AVENUE U 2ND FLOOR
BROOKLYN NY
11223-4033
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-5100
  • Fax: 718-382-0201
Mailing address:
  • Phone: 718-998-5100
  • Fax: 718-382-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number040858-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: