Provider Demographics
NPI:1144747221
Name:MINA SCHAFFT DMD PLLC
Entity Type:Organization
Organization Name:MINA SCHAFFT DMD PLLC
Other - Org Name:CHILDREN'S DENTISTRY OF WESTWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFFT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-905-9580
Mailing Address - Street 1:75 HOLLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4634
Mailing Address - Country:US
Mailing Address - Phone:617-905-9580
Mailing Address - Fax:
Practice Address - Street 1:321 WASHINGTON STREET
Practice Address - Street 2:UNIT 101
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-686-9789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty