Provider Demographics
NPI:1396842142
Name:MINER FAMILY DENTISTRY, P.A.
Entity Type:Organization
Organization Name:MINER FAMILY DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-625-2200
Mailing Address - Street 1:1010 DOWNING AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2461
Mailing Address - Country:US
Mailing Address - Phone:785-625-2200
Mailing Address - Fax:785-625-0079
Practice Address - Street 1:1010 DOWNING AVE STE 10
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2461
Practice Address - Country:US
Practice Address - Phone:785-625-2200
Practice Address - Fax:785-625-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100452140-AMedicaid
KS420749OtherBLUE CROSS BLUE SHIELD
KS0920275OtherTRICARE TDP