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General NPI Number Information
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NPI Number | 1275024192
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Entity Type | Individual
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Provider Name | BRIANNE ELIZABETH MEZO DDS
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Gender | Female
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Dates
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Enumeration Date | 05/26/2018
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 1500 W PARNALL RD
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City | JACKSON
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State | MI
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Zip | 49201-8660
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Country | US
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Telephone | 517-740-2895
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Fax |
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Provider Business Mailing Address
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Address Line | 5706 HORTON RD
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City | JACKSON
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State | MI
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Zip | 49201-9750
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Country | US
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Telephone | 517-740-2895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2901022635
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901022635
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License Number State | MI
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