MEDICARE: RONALD DAVID MIZRAHI 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	040858-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003827916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD DAVID MIZRAHI DDS

Provider Business Mailing Address
First Line	:	372 AVENUE U
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4033
Country	:	US
Telephone Number	:	718-998-5100
Fax Number	:	718-382-0201

Provider Business Practice Location Address
First Line	:	372 AVENUE U
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4033
Country	:	US
Telephone Number	:	718-998-5100
Fax Number	:	718-382-0201

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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