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General NPI Number Information
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NPI Number | 1871337592
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Entity Type | Organization
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Legal Business Name | MINTED DENTAL PC
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 2050 W CHESTER PIKE STE 4
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City | HAVERTOWN
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State | PA
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Zip | 19083-2742
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Country | US
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Telephone | 610-789-0178
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Fax |
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Provider Business Mailing Address
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Address Line | 124 LADBROKE DR
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City | EXTON
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State | PA
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Zip | 19341-2454
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Country | US
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Telephone | 215-779-3381
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAGINI SINGLA
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Credential | DMD
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Telephone | 215-779-3381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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