Provider Demographics
NPI:1114393360
Name:MINER, TRENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:
Last Name:MINER
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 1:2728 WESTMOOR CT SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5779
Mailing Address - Country:US
Mailing Address - Phone:801-376-9580
Mailing Address - Fax:
Practice Address - Street 1:1378 N MERIDIAN RD STE 150
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-1687
Practice Address - Country:US
Practice Address - Phone:208-606-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4738-PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry