Mina Boulos, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI03089400 Issued in NJ

Practice address

922 Route 35
Ocean, NJ 07712-4549

Phone

(848) 217-2029

NPI assigned

Mar 11, 2024

Last updated

Dec 29, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pavlushkin Dental LLC

  • General Practice Dentistry
  • Ocean Township, NJ
  • NPI 1477329332
  NPD

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766966400000",
    "number": "1629836010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 CRAWFORD PL",
            "city": "OLD BRIDGE",
            "state": "NJ",
            "postal_code": "088573403",
            "telephone_number": "732-501-9834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 ROUTE 35",
            "city": "OCEAN",
            "state": "NJ",
            "postal_code": "077124549",
            "telephone_number": "848-217-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULOS",
        "first_name": "MINA",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-11",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI03089400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Ann Bloomfield, RN
• J Gordon Boak, MD
• Edward S. Boim
• Samantha Louise Bono, PAC
• Ann Booth, PSY.D
• Laura Branigan, DMD
• Brenda Sahlin D.C.
• Bridge Linx
• Nicole Leigh Brinkman, PHARMD
• Meryle Bromberg, LCSW

• General Practice Dentistry in Ocean, NJ
• Providers in Ocean, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.