Provider Demographics
NPI:1790185809
Name:MINT DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:MINT DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-529-6468
Mailing Address - Street 1:329 RHODE ISLAND AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6815
Mailing Address - Country:US
Mailing Address - Phone:202-529-6468
Mailing Address - Fax:202-529-3052
Practice Address - Street 1:329 RHODE ISLAND AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6815
Practice Address - Country:US
Practice Address - Phone:202-529-6468
Practice Address - Fax:202-529-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10013551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty