# MIMOSA FAMILY DENTISTRY, PC.

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

## Provider details

- **NPI number:** 1891711388
- **Authorized official:** MR. LOC NGUYEN BUI D.M.D. (OWNER/ DENTIST)
- **Authorized official phone:** (717) 838-1338

## Contact information

- **Practice address:** 117 W CHERRY ST, PALMYRA, PA 17078-2303
- **Practice address phone:** (717) 838-1338
- **Practice address fax:** (717) 838-7003
- **Mailing address:** 117 W CHERRY ST, PALMYRA, PA 17078-2303
- **Mailing address phone:** (717) 838-1338
- **Mailing address fax:** (717) 838-7003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS-027312-L | PA | Yes |

## Other

- **Enumeration date:** 07/15/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 485649 | INSURANCE | PA |