Healthcare Provider Details

I. General information

NPI: 1770958167
Provider Name (Legal Business Name): MINT ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 WELLINGTON PL
ABERDEEN NJ
07747-1927
US

IV. Provider business mailing address

911 WELLINGTON PL
ABERDEEN NJ
07747-1927
US

V. Phone/Fax

Practice location:
  • Phone: 732-618-2614
  • Fax: 732-696-8124
Mailing address:
  • Phone: 732-618-2614
  • Fax: 732-696-8124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI02566201
License Number StateNJ

VIII. Authorized Official

Name: DR. STEPHANIE SHINMACHI
Title or Position: OWNER/ORTHODONTIST
Credential: DMD
Phone: 732-618-2614