Provider Demographics
NPI:1275024192
Name:MEZO, BRIANNE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:ELIZABETH
Last Name:MEZO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:NEELIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5706 HORTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9750
Mailing Address - Country:US
Mailing Address - Phone:517-740-2895
Mailing Address - Fax:
Practice Address - Street 1:1500 W PARNALL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8660
Practice Address - Country:US
Practice Address - Phone:517-740-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022635332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies