Provider Demographics
NPI:1902340003
Name:MINT SMILES DENTAL PC
Entity type:Organization
Organization Name:MINT SMILES DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-428-6378
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19456-0395
Mailing Address - Country:US
Mailing Address - Phone:610-428-6378
Mailing Address - Fax:
Practice Address - Street 1:42 E SUNBURY ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1700
Practice Address - Country:US
Practice Address - Phone:570-544-4785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty