MEDICARE: MZM 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

General Provider Information

NPI Number	:	1114070356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MZM DENTAL PLLC

Provider Business Mailing Address
First Line	:	3029 AVENUE V
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5448
Country	:	US
Telephone Number	:	718-332-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	3029 AVENUE V
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5448
Country	:	US
Telephone Number	:	718-332-4060
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. MICHAEL IRLIN
Credential	:	D.D.S
Telephone Number	:	718-332-4060

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/22/2020

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