Provider Demographics
NPI:1093046096
Name:MINA DENTAL ASSOCIATES OF DANVERS
Entity Type:Organization
Organization Name:MINA DENTAL ASSOCIATES OF DANVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SARRAF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-777-5556
Mailing Address - Street 1:2 ORCHARD LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3425
Mailing Address - Country:US
Mailing Address - Phone:978-777-5556
Mailing Address - Fax:978-777-5566
Practice Address - Street 1:2 ORCHARD LN
Practice Address - Street 2:SUITE 4
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-777-5556
Practice Address - Fax:978-777-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN204391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty