Provider Demographics
NPI:1912399643
Name:MINT DENTISTRY PLLC
Entity Type:Organization
Organization Name:MINT DENTISTRY PLLC
Other - Org Name:GARLAND MINT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FIELD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-821-6468
Mailing Address - Street 1:4441 BASS PRO DR STE 200
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4837
Mailing Address - Country:US
Mailing Address - Phone:214-821-6468
Mailing Address - Fax:
Practice Address - Street 1:4441 BASS PRO DR STE 200
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4837
Practice Address - Country:US
Practice Address - Phone:214-821-6468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental