Provider Demographics
NPI:1790135010
Name:MINA, MONIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONIR
Middle Name:
Last Name:MINA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 UPPER DUKE CRESCENT
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L6G 0E1
Mailing Address - Country:CA
Mailing Address - Phone:647-444-7772
Mailing Address - Fax:
Practice Address - Street 1:33080 GARFIELD RD
Practice Address - Street 2:DCF
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-1867
Practice Address - Country:US
Practice Address - Phone:586-293-8750
Practice Address - Fax:586-293-5990
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist