MEDICARE: DEAN YOSHITO MIZUNO D.D.S.

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	30253	CA

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	:	1164520227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN YOSHITO MIZUNO D.D.S.

Provider Business Mailing Address
First Line	:	87 E GREEN ST
Second Line	:	SUITE 310
City	:	PASADENA
State	:	CA
Zip	:	91105-2070
Country	:	US
Telephone Number	:	626-796-4718
Fax Number	:	626-796-1394

Provider Business Practice Location Address
First Line	:	87 E GREEN ST
Second Line	:	SUITE 310
City	:	PASADENA
State	:	CA
Zip	:	91105-2070
Country	:	US
Telephone Number	:	626-796-4718
Fax Number	:	626-796-1394

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/30/2009

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Directions to “ DEAN YOSHITO MIZUNO D.D.S.” Practice Location

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