Provider Demographics
NPI:1023485851
Name:STEVEN K MINER
Entity type:Organization
Organization Name:STEVEN K MINER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:KENNARD
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:228-424-0145
Mailing Address - Street 1:106 HALSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5315
Mailing Address - Country:US
Mailing Address - Phone:228-424-0145
Mailing Address - Fax:
Practice Address - Street 1:10409 BONEY AVE
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-4813
Practice Address - Country:US
Practice Address - Phone:228-424-0145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS202583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0064394Medicaid