MINT PREVENTATIVE DENTAL SPA CORNISH PLLC — NPI 1033920798 (Licensed & Credentialed Dental Hygienist in FRYEBURG, ME)

CMS-1500 Box 24J / 33a • NPI

1033920798

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

124Q00000X

Licensed & Credentialed Dental Hygienist

Box 32 Service Location & ZIP+4

19 PORTLAND ST STE 107, FRYEBURG, ME, 04037-1294

✓ 9-Digit EDI 837 ZIP+4 (04037-1294)

Practice Phone & Referral Fax

(207) 810-6019

Fax: (570) 218-7857

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1033920798 (MINT PREVENTATIVE DENTAL SPA CORNISH PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1033920798` (NPI-2 Organization / Facility)
Provider / Legal Name	MINT PREVENTATIVE DENTAL SPA CORNISH PLLC
Plain-English Specialty	Licensed & Credentialed Dental Hygienist NUCC Code: `124Q00000X` (Dental Hygienist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	19 PORTLAND ST STE 107, FRYEBURG, ME, 04037-1294
Practice Telephone / Fax	Tel: (207) 810-6019 \| Fax: (570) 218-7857
Administrative Mailing Address	12 SULLIVAN ST STE 107, BERWICK, ME, 03901-2925
Enumeration & Last Sync	Enumerated: 2025-01-14 \| CMS Record Updated: 2025-01-14
Authorized Official	JENNIFER DAVIS (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

19 PORTLAND ST STE 107, FRYEBURG, ME, 04037-1294

🗺️ Open in Google Maps 🏥 More Providers in FRYEBURG

🔒 Are you MINT PREVENTATIVE DENTAL SPA CORNISH PLLC? Get your Verified NPI Clinic Badge or request personal phone/address redaction →

Plain-English Taxonomy & CMS Crosswalk (124Q00000X)

What Does Taxonomy Code 124Q00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 124Q00000X translates to:
"Licensed & Credentialed Dental Hygienist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Dental Hygienist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MINT PREVENTATIVE DENTAL SPA CORNISH PLLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`124Q00000X` — Dental Hygienist Plain English: Licensed & Credentialed Dental Hygienist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.

Launch Bulk NPI Checker → JSON API Docs

MINT PREVENTATIVE DENTAL SPA CORNISH PLLC (NPI #1033920798)