Provider Demographics
NPI:1578855078
Name:MINTO, DAVID G JR (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:MINTO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19748 GREENO RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3836
Mailing Address - Country:US
Mailing Address - Phone:251-990-5959
Mailing Address - Fax:251-378-9032
Practice Address - Street 1:19748 GREENO RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3836
Practice Address - Country:US
Practice Address - Phone:251-990-5959
Practice Address - Fax:251-378-9032
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL6381-C204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery