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
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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