Provider Demographics
NPI:1851519482
Name:MINGES, CLYDE COYTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:COYTE
Last Name:MINGES
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 1:112 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2430
Mailing Address - Country:US
Mailing Address - Phone:252-443-9797
Mailing Address - Fax:252-443-5373
Practice Address - Street 1:112 NORTH CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-443-9797
Practice Address - Fax:252-443-5373
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist