Individual
DR. JEFFREY TYLON MINTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
988 OCEAN HWY W, SUPPLY, NC 28462-4060
(910) 754-7850
(910) 755-6334
Mailing address
PO BOX 329, SUPPLY, NC 28462-0329
(910) 754-7850
(910) 755-6334
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5832
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8996001
—
NC
01
—
96001
BLUE CROSS BLUE SHIELD
—
Enumeration date
06/29/2006
Last updated
07/08/2007
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