1. Home
  2. Directory
  3. Minnesota
  4. Shoreview
  5. Dentist
  6. NPI Profile
Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

MINA SAMY BOULOS DDS
NPI 1912837774
Dentist - General Practice in Shoreview, MN

Active since May 21, 2026
470 HIGHWAY 96 W STE 200, SHOREVIEW, MN 55126(651) 366-6880(651) 366-6880 Get Directions Write a Review

NPPES record added: May 21, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mina Samy Boulos Dds NPPES

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

MINA SAMY BOULOS DDS (NPI 1912837774) is an individual general practice provider in Shoreview, Minnesota, licensed in Minnesota (D15431) and active in the NPI registry since May 2026.

NPPES Registry Identity

NPI1912837774
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameMINA SAMY BOULOSCredential: DDS
Location Address470 HIGHWAY 96 W STE 200Shoreview, MN 55126-3214
Mailing Address7702 Narcissus Ln NMaple Grove, MN 55311-1849
Phone(651) 366-6880
Fax(651) 366-6880
Sole ProprietorYes
Enumeration DateMay 21, 2026
NPPES CertifiedMay 21, 2026
✔ NPI 1912837774 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in MN · D15431
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
470 HIGHWAY 96 W STE 200, Shoreview, MN 55126
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

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

DR. SAMY WASFY BOULOS DDS
Dentist (General Practice)
470 HIGHWAY 96 W STE 200
SHOREVIEW, MN 55126
Ramsey County (651) 366-6880

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 Mina Boulos's NPI number?

The NPI number for Mina Boulos is 1912837774. It was assigned to this individual provider in the NPPES registry on May 21, 2026.

Where is Mina Boulos located?

Mina Boulos practices at 470 Highway 96 W Ste 200, Shoreview, MN 55126. The listed phone number is (651) 366-6880.

What is Mina Boulos's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Mina Boulos was last updated on May 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.