Provider Demographics
NPI:1417158346
Name:MINER, MICHAEL MARK (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARK
Last Name:MINER
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 AMELIA DR
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-6063
Mailing Address - Country:US
Mailing Address - Phone:508-325-0583
Mailing Address - Fax:508-325-6734
Practice Address - Street 1:15 AMELIA DR
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-6063
Practice Address - Country:US
Practice Address - Phone:508-325-0583
Practice Address - Fax:508-325-6734
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist