Provider Demographics
NPI:1912472390
Name:MINT DENTAL LLC
Entity Type:Organization
Organization Name:MINT DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WUBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-586-5880
Mailing Address - Street 1:105 E OAK ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2978
Mailing Address - Country:US
Mailing Address - Phone:406-586-5880
Mailing Address - Fax:406-586-5881
Practice Address - Street 1:105 E OAK ST STE 2A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2978
Practice Address - Country:US
Practice Address - Phone:406-586-5880
Practice Address - Fax:406-586-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty