John Hideo Mizukawa II, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12918932 Issued in UT

Practice address

1308 E 900 S Ste a
St George, UT 84790-8730

Phone

(435) 673-1554

Fax

(435) 674-9967

NPI assigned

May 6, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2023 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oral Surgery Specialists of Tennessee, P.C.

  • Specialist
  • Oak Ridge, TN
  • NPI 1023129772
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1104261023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 E 900 S STE A",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847908730",
            "telephone_number": "435-673-1554",
            "fax_number": "865-482-8686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 E 900 S STE A",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847908730",
            "telephone_number": "435-673-1554",
            "fax_number": "435-674-9967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 N Main St Ste 204",
            "address_purpose": "LOCATION",
            "city": "Cedar City",
            "state": "UT",
            "postal_code": "847216177",
            "country_code": "US",
            "telephone_number": "435-867-1474",
            "fax_number": "435-867-1486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIZUKAWA",
        "first_name": "JOHN",
        "middle_name": "HIDEO",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-06",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "UT",
            "license": "12918932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorann C Mitchell, LCSW
• Hannah Brittnee Mitchell, NP
• Lauren Mitchell
• Paige Mitchell
• Regan Mitton
• John Hideo Mizukawa, D.D.S.
• Quamell Jafaar Mobley
• Moderm Medical Solutions Ut PLLC
• Modern Medical Injury Clinic LLC
• Lorraine Gail Moe

• Oral and Maxillofacial Surgery (Dentist) in St George, UT
• Providers in St George, UT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.