Provider Demographics
NPI:1346364494
Name:MINA DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:MINA DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SARRAF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-283-1692
Mailing Address - Street 1:94 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3710
Mailing Address - Country:US
Mailing Address - Phone:978-283-1692
Mailing Address - Fax:
Practice Address - Street 1:94 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-3710
Practice Address - Country:US
Practice Address - Phone:978-283-1692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty