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Organization
MINT ORAL SURGERY PLLC
Active
Organization
MINT ORAL SURGERY PLLC
Active
Other names
Mint Oral Surgery and Implant Center
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD WOODBINE (OWNER)
(718) 652-3699
Entity
Organization
Contact information
Practice address
4133 WHITE PLAINS RD, BRONX, NY 10466-3009
(718) 652-3699
(718) 374-5475
Mailing address
4133 WHITE PLAINS RD, BRONX, NY 10466-3009
(718) 652-3699
(718) 374-5475
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
NULL
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
NULL
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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