Provider Demographics
NPI:1275217598
Name:MINT32 DENTAL PLLC
Entity Type:Organization
Organization Name:MINT32 DENTAL PLLC
Other - Org Name:MINT32DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-519-0634
Mailing Address - Street 1:1351 ALAFAYA TRL STE 1017
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9100
Mailing Address - Country:US
Mailing Address - Phone:407-519-0634
Mailing Address - Fax:321-415-1071
Practice Address - Street 1:1351 ALAFAYA TRL STE 1017
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9100
Practice Address - Country:US
Practice Address - Phone:407-519-0634
Practice Address - Fax:321-415-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental