Provider Demographics
NPI:1952497174
Name:MINER, PHILIP BOYNTON (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:BOYNTON
Last Name:MINER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NW LOOP 410, SUITE 825
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2259
Mailing Address - Country:US
Mailing Address - Phone:210-341-5665
Mailing Address - Fax:210-341-2919
Practice Address - Street 1:1100 NW LOOP 410 STE 825
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2259
Practice Address - Country:US
Practice Address - Phone:210-934-5265
Practice Address - Fax:210-341-2919
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice