Provider Demographics
NPI:1285771923
Name:GERALD T MINICK DDS MS PC
Entity type:Organization
Organization Name:GERALD T MINICK DDS MS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:MINICK
Authorized Official - Suffix:
Authorized Official - Credentials:DD,S, MS
Authorized Official - Phone:303-627-6212
Mailing Address - Street 1:6020 S GUN CLUB RD
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5301
Mailing Address - Country:US
Mailing Address - Phone:303-627-6212
Mailing Address - Fax:303-627-1725
Practice Address - Street 1:6020 S GUN CLUB RD UNIT E1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5302
Practice Address - Country:US
Practice Address - Phone:720-277-5286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty