Provider Demographics
NPI:1245214139
Name:MINTZ, SYLVAN STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYLVAN
Middle Name:STEWART
Last Name:MINTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8618 TIMBER HILL LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4239
Mailing Address - Country:US
Mailing Address - Phone:301-983-0579
Mailing Address - Fax:301-605-7103
Practice Address - Street 1:10401 OLD GEORGETOWN RD
Practice Address - Street 2:#106
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1911
Practice Address - Country:US
Practice Address - Phone:301-530-8570
Practice Address - Fax:301-530-8572
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-04
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491230OtherMEDICARE PROVIDER
MD41813103OtherCAREFIRST BLUE CROSS
MD491230OtherMEDICARE PROVIDER