Organization
MINT ORAL SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLY LOTHMAN (REGIONAL DIRECTOR)
(214) 821-6468
Entity
Organization
Contact information
Practice address
2805 E GRAPEVINE MILLS CIR STE 180, GRAPEVINE, TX 76051-1214
(214) 821-6468
Mailing address
5656 N CENTRAL EXPY UNIT 400, DALLAS, TX 75206-0949
(214) 821-6468
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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