Provider Demographics
NPI:1336163666
Name:MINK, MITCHELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:MINK
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 1:280 MAMARONECK AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605
Mailing Address - Country:US
Mailing Address - Phone:914-948-1110
Mailing Address - Fax:914-428-3288
Practice Address - Street 1:280 MAMARONECK AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605
Practice Address - Country:US
Practice Address - Phone:914-948-1110
Practice Address - Fax:914-428-3288
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0371141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02587662Medicaid