MEDICARE: MELISSA KAREN KRIZNER-MEZA 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	DN27130	FL

General Provider Information

NPI Number	:	1902537673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KAREN KRIZNER-MEZA DMD

Provider Business Mailing Address
First Line	:	4643 SW 44TH LN
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-4937
Country	:	US
Telephone Number	:	954-319-8004
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 SW MAIN BLVD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-7050
Country	:	US
Telephone Number	:	386-752-2480
Fax Number	:

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

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	06/22/2022

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