Provider Demographics
NPI:1144492984
Name:MINTZ, SHALOM (DDS, MS, PC)
Entity type:Individual
Prefix:DR
First Name:SHALOM
Middle Name:
Last Name:MINTZ
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 ROUTE 45 STE 201
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1116
Mailing Address - Country:US
Mailing Address - Phone:845-259-2500
Mailing Address - Fax:845-406-4048
Practice Address - Street 1:873 ROUTE 45 STE 201
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1116
Practice Address - Country:US
Practice Address - Phone:845-259-2500
Practice Address - Fax:845-406-4048
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052148122300000X
NJ22DI02342800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist