Provider Demographics
NPI:1225259740
Name:MINCHAU, GARY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:MINCHAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1736 LYTER DRIVE
Mailing Address - Street 2:WESTMONT SHOPPING CENTER
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1206
Mailing Address - Country:US
Mailing Address - Phone:814-255-6831
Mailing Address - Fax:814-254-1521
Practice Address - Street 1:1736 LYTER DRIVE
Practice Address - Street 2:WESTMONT SHOPPING CENTER
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1206
Practice Address - Country:US
Practice Address - Phone:814-255-6831
Practice Address - Fax:814-254-1521
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS017849L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice