Provider Demographics
NPI:1801221882
Name:ROBERT H. MINER DDS, INC
Entity Type:Organization
Organization Name:ROBERT H. MINER DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-420-6775
Mailing Address - Street 1:12686 PICRUS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4121
Mailing Address - Country:US
Mailing Address - Phone:760-420-6775
Mailing Address - Fax:
Practice Address - Street 1:12686 PICRUS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-4121
Practice Address - Country:US
Practice Address - Phone:760-420-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60272261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery