Organization
MYNT DENTAL RACINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SASAN MOLAVI DDS (PRESIDENT / OWNER)
(630) 381-8281
Entity
Organization
Contact information
Practice address
6100 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-4000
(262) 999-9998
Mailing address
2731 MANNHEIM RD, FRANKLIN PARK, IL 60131-2219
(630) 381-8281
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/03/2018
Last updated
06/16/2021
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