Mark Douglas Mintline, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

62702 Issued in CA

Practice address

51 N. 39TH Street
Suite 106 Medical Arts Building
Philadelphia, PA 19104-2640

Phone

(215) 662-8060

Fax

(215) 243-3284

NPI assigned

Aug 1, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 31, 2022 through Mar 31, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788998400000",
    "number": "1043642069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 N. 39TH STREET",
            "address_2": "SUITE 106 MEDICAL ARTS BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042640",
            "telephone_number": "215-662-8060",
            "fax_number": "215-243-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N. 39TH STREET",
            "address_2": "SUITE 106 MEDICAL ARTS BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042640",
            "telephone_number": "215-662-8060",
            "fax_number": "215-243-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINTLINE",
        "first_name": "MARK",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-01",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "62702",
            "primary": true
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "CA",
            "license": "62702",
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "PA",
            "license": "DS045628",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barby Minoza
• Minsec Treatment Center
• Minsec Treatment LLC
• Chelsea Alexandra Minsky, LPC
• Mint Condition Extensions Company
• Natalie Minto, M.D.
• Jane E Minturn, M.D.
• Mintz Speech Pathology, LLC
• Avital Mintz-Morgenthau
• Hallie Elise Mintz, MS

• Dentist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.