Provider Demographics
NPI:1811068026
Name:MINCER, EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:MINCER
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 1:1910 BULL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2508
Mailing Address - Country:US
Mailing Address - Phone:803-254-7696
Mailing Address - Fax:803-254-7697
Practice Address - Street 1:1910 BULL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2508
Practice Address - Country:US
Practice Address - Phone:803-254-7696
Practice Address - Fax:803-254-7697
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ22360Medicaid