Provider Demographics
NPI:1043967250
Name:BROOKLYN MINT DENTAL, PLLC
Entity Type:Organization
Organization Name:BROOKLYN MINT DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE Q.
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-819-1947
Mailing Address - Street 1:561 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-4878
Mailing Address - Country:US
Mailing Address - Phone:718-360-0365
Mailing Address - Fax:
Practice Address - Street 1:561 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4878
Practice Address - Country:US
Practice Address - Phone:718-360-0365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental