MEDICARE: MZDENTAL PC

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	046369	NY

General Provider Information

NPI Number	:	1598927055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MZDENTAL PC

Provider Business Mailing Address
First Line	:	2525 NOSTRAND AVE
Second Line	:	SUITE 1P
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4749
Country	:	US
Telephone Number	:	718-252-2479
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 NOSTRAND AVE
Second Line	:	SUITE 1P
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4749
Country	:	US
Telephone Number	:	718-252-2479
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	MARINA ZILBERT
Credential	:
Telephone Number	:	718-252-2479

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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