MEDICARE: DENA RACHEL MIZRAHI DMD

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	1223P0221X	Pediatric Dentistry	DN19747	FL

General Provider Information

NPI Number	:	1205269396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENA RACHEL MIZRAHI DMD

Provider Business Mailing Address
First Line	:	3020 HARTLEY RD STE 210
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8206
Country	:	US
Telephone Number	:	904-395-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	1584 KINGSLEY AVE STE 1
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4502
Country	:	US
Telephone Number	:	904-264-5437
Fax Number	:

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

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	03/22/2022

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