Minty Dental Boutique

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MINTY DENTAL BOUTIQUE

Practice address

4200 W Peterson Ave Ste 136
Chicago, IL 60646-6052

Phone

(773) 286-5286

Fax

(773) 286-5331

NPI assigned

Sep 12, 2024

Last updated

Sep 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tamara Marjan, DMDNPI 1841783651

Title

Owner

Phone

(936) 239-0753

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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.

• Tamara Marjan, DMD

  • Dentist
  • Tinley Park, IL
  • NPI 1841783651
  NPD Authorized official
• Irene T. Theodore, DDS

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1871756767
  NPD (past)
• Terri S. Tiersky, D.D.S.

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1528130911
  NPD (past)

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

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1457187775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 W PETERSON AVE STE 136",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466052",
            "telephone_number": "773-286-5286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 W PETERSON AVE STE 136",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466052",
            "telephone_number": "773-286-5286",
            "fax_number": "773-286-5331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINTY DENTAL BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-12",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "MARJAN",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-239-0753",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miata Lanae Minor
• Penelope Minor
• Reese Minshew, PHD
• Mint Dental Care LTD
• Jessica Lynne Minton, PT
• Ari David Mintz, M.D.
• David Anthony Mintz, MD
• Judith Wood Mintz, MSW
• Michael Royal Mintz
• Rachel Mintz, LCSW

• Dental Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.