Provider Demographics
NPI:1164755237
Name:MICHAEL L. MINTEN DDS
Entity Type:Organization
Organization Name:MICHAEL L. MINTEN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MINTEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-443-5195
Mailing Address - Street 1:411 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-443-5195
Mailing Address - Fax:573-449-1269
Practice Address - Street 1:411 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4915
Practice Address - Country:US
Practice Address - Phone:573-443-5195
Practice Address - Fax:573-449-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0148111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty