# MINT ORAL SURGERY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033625736
- **Authorized official:** CARLY LOTHMAN (REGIONAL DIRECTOR)
- **Authorized official phone:** (214) 821-6468

## Contact information

- **Practice address:** 2805 E GRAPEVINE MILLS CIR STE 180, GRAPEVINE, TX 76051-1214
- **Practice address phone:** (214) 821-6468
- **Mailing address:** 5656 N CENTRAL EXPY UNIT 400, DALLAS, TX 75206-0949
- **Mailing address phone:** (214) 821-6468

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/18/2017
- **Last updated:** 12/18/2017