MEDICARE: DR. SYLVAN STEWART MINTZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4351	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	491230	OTHER	MD	MEDICARE PROVIDER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	41813103	OTHER	MD	CAREFIRST BLUE CROSS

General Provider Information

NPI Number	:	1245214139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYLVAN STEWART MINTZ DDS

Provider Business Mailing Address
First Line	:	8618 TIMBER HILL LN
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-4239
Country	:	US
Telephone Number	:	301-983-0579
Fax Number	:	301-605-7103

Provider Business Practice Location Address
First Line	:	10401 OLD GEORGETOWN RD
Second Line	:	#106
City	:	BETHESDA
State	:	MD
Zip	:	20814-1911
Country	:	US
Telephone Number	:	301-530-8570
Fax Number	:	301-530-8572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2005
Last Update Date	:	08/30/2011

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