Healthcare Provider Details

I. General information

NPI: 1427119544
Provider Name (Legal Business Name): MINA SAAD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 LAKEMONT PARK BLVD
ALTOONA PA
16602-5943
US

IV. Provider business mailing address

175 LAKEMONT PARK BLVD
ALTOONA PA
16602-5943
US

V. Phone/Fax

Practice location:
  • Phone: 814-201-2102
  • Fax:
Mailing address:
  • Phone: 814-201-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS036597
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02297000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: