MEDICARE: BRANDON MIZNER 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	7180	NE

General Provider Information

NPI Number	:	1780083154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON MIZNER D.D.S.

Provider Business Mailing Address
First Line	:	2672 33RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2314
Country	:	US
Telephone Number	:	402-564-7575
Fax Number	:	402-564-1818

Provider Business Practice Location Address
First Line	:	2672 33RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2314
Country	:	US
Telephone Number	:	402-564-7575
Fax Number	:	402-564-1818

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	04/11/2016

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