Provider Demographics
NPI:1669647996
Name:MNM DENTAL STUDIO PLLC
Entity Type:Organization
Organization Name:MNM DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR/RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-209-0012
Mailing Address - Street 1:13933 W GRAND AVE
Mailing Address - Street 2:SUITE #302
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2435
Mailing Address - Country:US
Mailing Address - Phone:623-209-0012
Mailing Address - Fax:623-537-9184
Practice Address - Street 1:13933 W GRAND AVE
Practice Address - Street 2:SUITE #302
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2435
Practice Address - Country:US
Practice Address - Phone:623-209-0012
Practice Address - Fax:623-537-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty