Provider Demographics
NPI:1447396759
Name:MINTALAR, ERIC R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:R
Last Name:MINTALAR
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 1:3220 COUNTY ROAD 10
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3073
Mailing Address - Country:US
Mailing Address - Phone:763-561-6320
Mailing Address - Fax:763-561-6321
Practice Address - Street 1:3220 COUNTY ROAD 10
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3073
Practice Address - Country:US
Practice Address - Phone:763-561-6320
Practice Address - Fax:763-561-6321
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND105531223G0001X
CA368021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice