Provider Demographics
NPI:1669033452
Name:JAIN, MINAL (DMD)
Entity Type:Individual
Prefix:
First Name:MINAL
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14313 TYBURN TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5062
Mailing Address - Country:US
Mailing Address - Phone:916-801-6365
Mailing Address - Fax:
Practice Address - Street 1:825 E RUNDBERG LN STE A1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4809
Practice Address - Country:US
Practice Address - Phone:408-835-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice