MEDICARE: DR. DANIELL JASON MISHAAN 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	1223G0001X	General Practice Dentistry	051515	NY

General Provider Information

NPI Number	:	1558401042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELL JASON MISHAAN DMD

Provider Business Mailing Address
First Line	:	784 COLUMBUS AVE
Second Line	:	APT 3-E
City	:	NEW YORK
State	:	NY
Zip	:	10025-5901
Country	:	US
Telephone Number	:	718-686-7600
Fax Number	:	718-686-8616

Provider Business Practice Location Address
First Line	:	571 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3807
Country	:	US
Telephone Number	:	718-686-7600
Fax Number	:	718-686-8616

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

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

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