Provider Demographics
NPI:1609032820
Name:MINASIAN, KERNNETH PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KERNNETH
Middle Name:PAUL
Last Name:MINASIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2002
Mailing Address - Country:US
Mailing Address - Phone:603-889-7700
Mailing Address - Fax:603-882-9908
Practice Address - Street 1:15 BROAD STREET
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064
Practice Address - Country:US
Practice Address - Phone:603-889-7700
Practice Address - Fax:603-882-9908
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice