Provider Demographics
NPI:1740773092
Name:MINKUS, TAYLOR (DMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:MINKUS
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 1:11240 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4713
Mailing Address - Country:US
Mailing Address - Phone:727-398-0085
Mailing Address - Fax:727-397-1420
Practice Address - Street 1:11240 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4713
Practice Address - Country:US
Practice Address - Phone:727-398-0085
Practice Address - Fax:727-397-1420
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist