Provider Demographics
NPI:1578642864
Name:MIZELL, BARBARA JOAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JOAN
Last Name:MIZELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PLACE DE LA FONTAINE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-4905
Mailing Address - Country:US
Mailing Address - Phone:850-393-3705
Mailing Address - Fax:
Practice Address - Street 1:415 MOUNTAIN DR STE 4
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:850-424-6996
Practice Address - Fax:850-424-6914
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN123641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice