MEDICARE: MINT DENTAL WORKS

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1932553823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINT DENTAL WORKS

Provider Business Mailing Address
First Line	:	1401 SE MORRISON ST STE 108
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2777
Country	:	US
Telephone Number	:	503-254-1323
Fax Number	:	503-254-6626

Provider Business Practice Location Address
First Line	:	1401 SE MORRISON ST STE 108
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2777
Country	:	US
Telephone Number	:	503-254-1323
Fax Number	:	503-254-6626

Authorized Official
Title or Position	:	DMD
Name	:	JASON MCMILLAN
Credential	:
Telephone Number	:	503-254-1323

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	04/18/2016

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Directions to “MINT DENTAL WORKS ” Practice Location

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