Provider Demographics
NPI:1306379185
Name:MINT DENTAL CARE LTD
Entity Type:Organization
Organization Name:MINT DENTAL CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUI JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-254-1008
Mailing Address - Street 1:4635 W 63RD ST
Mailing Address - Street 2:STE D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5559
Mailing Address - Country:US
Mailing Address - Phone:872-254-1008
Mailing Address - Fax:847-665-0416
Practice Address - Street 1:4635 W 63RD ST
Practice Address - Street 2:STE D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5559
Practice Address - Country:US
Practice Address - Phone:872-254-1008
Practice Address - Fax:847-665-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty