NPIMap

Organization Active NPI

Mint Preventative Dental Spa, PLLC

  • Dental Clinic/Center
  • Berwick, ME
National Provider Identifier
1609502830
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MINT PREVENTATIVE DENTAL SPA, PLLC
Practice address
12 Sullivan St Ste 107
Berwick, ME 03901-2925
Phone
(207) 810-6019
NPI assigned
Jul 29, 2022
Last updated
Apr 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Authorized official

Name
Daniele West, IPDHNPI 1144971318
Title
Owner
Phone
(603) 986-3139

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

12 Sullivan St Ste 107
Berwick, ME 03901-2925

Mailing address

12 Sullivan St Ste 107
Berwick, ME 03901-2925
Phone (207) 810-6019

Other practice location 1

19 Portland St
Fryeburg, ME 04037-1294
Phone (207) 256-7606

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1659052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743465600000",
    "number": "1609502830",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SULLIVAN ST STE 107",
            "city": "BERWICK",
            "state": "ME",
            "postal_code": "039012925",
            "telephone_number": "207-810-6019"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19 Portland St",
            "address_purpose": "LOCATION",
            "city": "Fryeburg",
            "state": "ME",
            "postal_code": "040371294",
            "country_code": "US",
            "telephone_number": "207-256-7606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINT PREVENTATIVE DENTAL SPA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-29",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "DANIELE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-986-3139",
        "authorized_official_credential": "IPDH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwick, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.