Provider Demographics
NPI:1720007867
Name:MINEHART, STEPHEN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:MINEHART
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 1:1306 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2027
Mailing Address - Country:US
Mailing Address - Phone:617-527-1600
Mailing Address - Fax:617-527-8469
Practice Address - Street 1:1306 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2027
Practice Address - Country:US
Practice Address - Phone:617-527-1600
Practice Address - Fax:617-527-8469
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice