Provider Demographics
NPI:1598350100
Name:MINYE CENTER FOR RECONSTRUCTIVE DENTISTRY & ORAL SURGERY, PC
Entity Type:Organization
Organization Name:MINYE CENTER FOR RECONSTRUCTIVE DENTISTRY & ORAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:MALOUS
Authorized Official - Last Name:MINYE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MHCM
Authorized Official - Phone:818-312-5819
Mailing Address - Street 1:25 HIGHLAND PARK VILLAGE
Mailing Address - Street 2:BLDG 100 STE171
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18981 VENTURA BLVD
Practice Address - Street 2:2ND FLOOR, SUITE 200
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-312-5819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty