Provider Demographics
NPI:1962122689
Name:SCOTT A MINNIEAR DDS PC
Entity type:Organization
Organization Name:SCOTT A MINNIEAR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MINNIEAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-787-8880
Mailing Address - Street 1:306 W WASHINGTON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2141
Mailing Address - Country:US
Mailing Address - Phone:517-787-8880
Mailing Address - Fax:517-787-8888
Practice Address - Street 1:306 W WASHINGTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2141
Practice Address - Country:US
Practice Address - Phone:517-787-8880
Practice Address - Fax:517-787-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental