Provider Demographics
NPI:1346470788
Name:MINYARD, DAVID D (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:MINYARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MEDICAL PARK BLVD.
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-330-9444
Mailing Address - Fax:405-330-7828
Practice Address - Street 1:950 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3024
Practice Address - Country:US
Practice Address - Phone:405-330-9444
Practice Address - Fax:405-330-7828
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist