Provider Demographics
NPI:1528020567
Name:MINARCHEK, MICHAEL J (DR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MINARCHEK
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WEST PLANE ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106
Mailing Address - Country:US
Mailing Address - Phone:513-734-0120
Mailing Address - Fax:513-734-2029
Practice Address - Street 1:420 WEST PLANE ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106
Practice Address - Country:US
Practice Address - Phone:513-734-0120
Practice Address - Fax:513-734-2029
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016322122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist