Provider Demographics
NPI:1508073818
Name:MIZNER, MELVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:
Last Name:MIZNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 VALIANT WAY
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-6613
Mailing Address - Country:US
Mailing Address - Phone:978-535-8244
Mailing Address - Fax:978-535-8240
Practice Address - Street 1:7 ESSEX GREEN DR
Practice Address - Street 2:SUITE 54
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2961
Practice Address - Country:US
Practice Address - Phone:978-535-8244
Practice Address - Fax:978-535-8240
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA87431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice