Provider Demographics
NPI:1700053634
Name:BARRY A. MENTZEL, D.D.S., P.C.
Entity Type:Organization
Organization Name:BARRY A. MENTZEL, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MENTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-772-1880
Mailing Address - Street 1:19925 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1069
Mailing Address - Country:US
Mailing Address - Phone:586-772-1880
Mailing Address - Fax:586-772-5837
Practice Address - Street 1:19925 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1069
Practice Address - Country:US
Practice Address - Phone:586-772-1880
Practice Address - Fax:586-772-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM100051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty