NPIMap

Organization Active NPI

Mynt Dental Racine LLC

  • General Practice Dentistry
  • Mount Pleasant, WI
National Provider Identifier
1235628454
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MYNT DENTAL RACINE LLC
Practice address
6100 Washington Ave
Mount Pleasant, WI 53406-4000
Phone
(262) 999-9998
NPI assigned
May 3, 2018
Last updated
Jun 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Authorized official

Name
Dr. Sasan Molavi, DDSNPI 1467680504
Title
President / Owner
Phone
(630) 381-8281

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

6100 Washington Ave
Mount Pleasant, WI 53406-4000

Mailing address

2731 Mannheim Rd
Franklin Park, IL 60131-2219
Phone (630) 381-8281

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623801600000",
    "number": "1235628454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2731 MANNHEIM RD",
            "city": "FRANKLIN PARK",
            "state": "IL",
            "postal_code": "601312219",
            "telephone_number": "630-381-8281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 WASHINGTON AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064000",
            "telephone_number": "262-999-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYNT DENTAL RACINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-03",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A",
        "authorized_official_last_name": "MOLAVI",
        "authorized_official_first_name": "SASAN",
        "authorized_official_title_or_position": "PRESIDENT / OWNER",
        "authorized_official_telephone_number": "630-381-8281",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; 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.