Provider Demographics
NPI:1982747135
Name:MINER, DAVID PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PHILLIP
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 1:1002 HENRIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8504
Mailing Address - Country:US
Mailing Address - Phone:215-663-8836
Mailing Address - Fax:215-663-5639
Practice Address - Street 1:6936 SYLVESTER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1821
Practice Address - Country:US
Practice Address - Phone:215-342-2538
Practice Address - Fax:215-663-5639
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020905L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist