Provider Demographics
NPI:1528140431
Name:MINFORD, JAMES DEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEAN
Last Name:MINFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2673 LEECHBURG RD.
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3028
Mailing Address - Country:US
Mailing Address - Phone:724-335-0550
Mailing Address - Fax:724-335-9768
Practice Address - Street 1:2673 LEECHBURG RD.
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3028
Practice Address - Country:US
Practice Address - Phone:724-335-0550
Practice Address - Fax:724-335-9768
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO18655L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADSO18655LOtherPA STATE DENTAL LICENSE