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General NPI Number Information
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NPI Number | 1730070665
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Entity Type | Individual
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Provider Name | MINA OH
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Gender |
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 4164 CARMICHAEL RD
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City | MONTGOMERY
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State | AL
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Zip | 36106-3600
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Country | US
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Telephone | 334-277-2980
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 BEACON PKWY E UNIT 1121
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D.007452-C1
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License Number State | AL
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