Provider Demographics
NPI:1043557127
Name:MZM DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:MZM DENTAL GROUP PLLC
Other - Org Name:FAMILY SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GELFAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-376-4200
Mailing Address - Street 1:1985 OCEAN AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6815
Mailing Address - Country:US
Mailing Address - Phone:718-376-4200
Mailing Address - Fax:718-376-4202
Practice Address - Street 1:1985 OCEAN AVE APT 1D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6815
Practice Address - Country:US
Practice Address - Phone:718-376-4200
Practice Address - Fax:718-376-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02758001Medicaid