Provider Demographics
NPI:1861003121
Name:MIND ALGN LLC
Entity Type:Organization
Organization Name:MIND ALGN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-269-2971
Mailing Address - Street 1:7920 NORFOLK AVE STE 920
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2524
Mailing Address - Country:US
Mailing Address - Phone:301-656-3700
Mailing Address - Fax:240-223-3755
Practice Address - Street 1:7920 NORFOLK AVE STE 920
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2524
Practice Address - Country:US
Practice Address - Phone:301-656-3700
Practice Address - Fax:240-223-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty