Mint Preventative Dental Spa Cornish PLLC

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

Legal business name

MINT PREVENTATIVE DENTAL SPA CORNISH PLLC

Practice address

19 Portland St Ste 107
Fryeburg, ME 04037-1294

Phone

(207) 810-6019

Fax

(570) 218-7857

NPI assigned

Jan 14, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Davis, IPDHNPI 1558022939

Title

Owner

Phone

(603) 682-3295

Specialties & licenses 1

Addresses

Other names 1

• Fryeburg Family Dental Doing business as

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Lynn Davis

  • Dental Hygienist
  • Berwick, ME
  • NPI 1558022939
  NPD Authorized official
• Gabrielle Quigley

  • Dental Hygienist
  • Fryeburg, ME
  • NPI 1366245904
  NPD
• Shannon Christine Taber, RDH, IPDH

  • Dental Hygienist
  • Berwick, ME
  • NPI 1700766086
  NPD
• Virginia Edelmira Pyburn, IPDH

  • Dental Hygienist
  • Berwick, ME
  • NPI 1316628811
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1033920798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 SULLIVAN ST STE 107",
            "city": "BERWICK",
            "state": "ME",
            "postal_code": "039012925",
            "telephone_number": "207-810-6019",
            "fax_number": "570-218-7857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 PORTLAND ST STE 107",
            "city": "FRYEBURG",
            "state": "ME",
            "postal_code": "040371294",
            "telephone_number": "207-810-6019",
            "fax_number": "570-218-7857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINT PREVENTATIVE DENTAL SPA CORNISH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-14",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-682-3295",
        "authorized_official_credential": "IPDH"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fryeburg Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maine School Administrative District No 72
• Maine School Administrative District No 72
• Lisa McAllister, DO
• Catherine McCullum
• Lynn Meehan
• Mountain View Direct Care, LLC
• Peter W. Murphy, M.D.
• N Scott Ferguson O.D.
• James Thomas Oliver, RX
• Rebecca Paradis

• Dental Hygienist in Fryeburg, ME
• Providers in Fryeburg, ME by specialty
• Dental Hygienist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.