# MINT ORAL SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mint Oral Surgery and Implant Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598447328
- **Authorized official:** EDWARD WOODBINE (OWNER)
- **Authorized official phone:** (718) 652-3699

## Contact information

- **Practice address:** 4133 WHITE PLAINS RD, BRONX, NY 10466-3009
- **Practice address phone:** (718) 652-3699
- **Practice address fax:** (718) 374-5475
- **Mailing address:** 4133 WHITE PLAINS RD, BRONX, NY 10466-3009
- **Mailing address phone:** (718) 652-3699
- **Mailing address fax:** (718) 374-5475

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |
| 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