Provider Demographics
NPI:1205269396
Name:MIZRAHI, DENA RACHEL (DMD)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:RACHEL
Last Name:MIZRAHI
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 1:3020 HARTLEY RD STE 210
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8206
Mailing Address - Country:US
Mailing Address - Phone:904-395-7772
Mailing Address - Fax:
Practice Address - Street 1:1584 KINGSLEY AVE STE 1
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4502
Practice Address - Country:US
Practice Address - Phone:904-264-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN197471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry