Provider Demographics
NPI:1831402957
Name:MINGEL, MARC
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MINGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2408
Mailing Address - Country:US
Mailing Address - Phone:646-554-3241
Mailing Address - Fax:
Practice Address - Street 1:1261 FURNACE BROOK PKWY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4721
Practice Address - Country:US
Practice Address - Phone:617-471-6970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18554941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice