MEDICARE: DZ DENTAL, PLLC

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	1223G0001X	General Practice Dentistry	DS0000009160	TN

General Provider Information

NPI Number	:	1033500186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DZ DENTAL, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2153 GALLATIN PIKE N
Second Line	:
City	:	MADISON
State	:	TN
Zip	:	37115-2003
Country	:	US
Telephone Number	:	315-454-6000
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER RELATIONS
Name	:	MIKA WEISS
Credential	:
Telephone Number	:	315-454-6000

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	02/11/2015

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