Provider Demographics
NPI:1639515703
Name:MINA, EHAB (DMD)
Entity Type:Individual
Prefix:DR
First Name:EHAB
Middle Name:
Last Name:MINA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1022
Mailing Address - Country:US
Mailing Address - Phone:610-630-2373
Mailing Address - Fax:610-630-5682
Practice Address - Street 1:1009 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-1022
Practice Address - Country:US
Practice Address - Phone:610-630-2373
Practice Address - Fax:610-630-5682
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 030 144L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist