Organization
MIMOSA FAMILY DENTISTRY, PC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOC NGUYEN BUI D.M.D. (OWNER/ DENTIST)
(717) 838-1338
Entity
Organization
Contact information
Practice address
117 W CHERRY ST, PALMYRA, PA 17078-2303
(717) 838-1338
(717) 838-7003
Mailing address
117 W CHERRY ST, PALMYRA, PA 17078-2303
(717) 838-1338
(717) 838-7003
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS-027312-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
485649
INSURANCE
PA
Enumeration date
07/15/2006
Last updated
08/22/2020
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