MEDICARE: DR. MITCHELL STUART PASENKOFF D.M.D.

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	16711	MA

General Provider Information

NPI Number	:	1356313746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL STUART PASENKOFF D.M.D.

Provider Business Mailing Address
First Line	:	146 MAIN ST
Second Line	:	SUITE 2A
City	:	NORFOLK
State	:	MA
Zip	:	02056-1322
Country	:	US
Telephone Number	:	508-528-5351
Fax Number	:	508-541-7410

Provider Business Practice Location Address
First Line	:	146 MAIN ST
Second Line	:	SUITE 2A
City	:	NORFOLK
State	:	MA
Zip	:	02056-1322
Country	:	US
Telephone Number	:	508-528-5351
Fax Number	:	508-541-7410

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/08/2007

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