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DR. MARK DOUGLAS MINTLINE DDS
NPI 1043642069
Dentist in Pomona, CA

Active since August 01, 2013Opted out of Medicare · through Mar 31, 2028
795 E. SECOND ST., SUITE 8, POMONA, CA 91766(909) 706-3910(909) 469-8650 Get Directions Write a Review

NPPES record last updated: October 30, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 30, 2018, Apr 16, 2018 (2 updates tracked since 2018).

About Dr. Mark Douglas Mintline Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MARK DOUGLAS MINTLINE DDS (NPI 1043642069) is an individual dentist in Pomona, California, licensed in California (62702) and active in the NPI registry since August 2013. He has opted out of Medicare through March 31, 2028.

NPPES Registry Identity

NPI1043642069
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameDR. MARK DOUGLAS MINTLINECredential: DDS
Location Address795 E. SECOND ST., SUITE 8Pomona, CA 91766
Mailing Address795 E. Second St., Suite 8Pomona, CA 91766-2007 · (909) 706-3910 · Fax (909) 469-8650
Phone(909) 706-3910
Fax(909) 469-8650
Sole ProprietorNo
Enumeration DateAugust 1, 2013
Last NPPES UpdateOctober 30, 20182 updates tracked since enumeration
✔ NPI 1043642069 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in CA · 62702
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Also ListedDentist · Oral and Maxillofacial PathologyTaxonomy 1223P0106X · License 62702 (CA)
795 E. SECOND ST., Pomona, CA 91766
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Mark Douglas Mintline Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 31, 2022 through March 31, 2028.

Opt-Out Effective DateMarch 31, 2022
Opt-Out In Effect ThroughMarch 31, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 91766 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOSEPH M GRAY O.D.
Optometrist
795 E. SECOND ST., SUITE 2
POMONA, CA 91766
Los Angeles County (909) 706-3899
JOSEPHINE LIN O.D
Optometrist
795 E. SECOND ST., SUITE 2
POMONA, CA 91766
Los Angeles County (909) 706-3899
DR. TRANG BICH NGUYEN DDS
Dentist (Endodontics)
795 E. SECOND ST., SUITE 8
POMONA, CA 91766
Los Angeles County (909) 706-3910
RAY M. YUTANI DO
Family Medicine
795 E. SECOND ST., SUITE 5
POMONA, CA 91766
Los Angeles County (909) 865-2565
DR. BRADLEY E HABERMEHL OD
Optometrist
795 E. SECOND ST., SUITE 2
POMONA, CA 91766
Los Angeles County (909) 706-3899
DR. SABA SADRA DPM
Podiatrist
795 E. SECOND ST., SUITE 7
POMONA, CA 91766
Los Angeles County (909) 706-3877
DR. AN DUY VO OD
Optometrist
795 E. SECOND ST., SUITE 2
POMONA, CA 91766
Los Angeles County (909) 706-3899
PHILIP KWOK O.D.
Optometrist
795 E. SECOND ST., SUITE 2
POMONA, CA 91766
Los Angeles County (909) 706-3899

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Mintline's NPI number?

The NPI number for Mark Mintline is 1043642069. It was assigned to this individual provider in the NPPES registry on August 1, 2013.

Where is Mark Mintline located?

Mark Mintline practices at 795 E. Second St. Suite 8, Pomona, CA 91766. The listed phone number is (909) 706-3910.

What is Mark Mintline's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Mark Mintline enrolled in Medicare?

No. Mark Mintline has opted out of Medicare through March 31, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Mark Mintline was last updated on October 30, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.