Provider Demographics
NPI:1770958167
Name:MINT ORTHODONTICS LLC
Entity type:Organization
Organization Name:MINT ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINMACHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-618-2614
Mailing Address - Street 1:911 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1927
Mailing Address - Country:US
Mailing Address - Phone:732-618-2614
Mailing Address - Fax:732-696-8124
Practice Address - Street 1:911 WELLINGTON PL
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1927
Practice Address - Country:US
Practice Address - Phone:732-618-2614
Practice Address - Fax:732-696-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025662011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty