MEDICARE: MINTON FAMILY DENTAL CARE RT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1467316133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINTON FAMILY DENTAL CARE RT

Provider Business Mailing Address
First Line	:	210 CEDAR FORK RD
Second Line	:
City	:	TAZEWELL
State	:	TN
Zip	:	37879-3201
Country	:	US
Telephone Number	:	360-513-5328
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 CEDAR FORK RD
Second Line	:
City	:	TAZEWELL
State	:	TN
Zip	:	37879-3201
Country	:	US
Telephone Number	:	360-513-5328
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEARSTIN STALLINGS
Credential	:
Telephone Number	:	360-513-5328

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “MINTON FAMILY DENTAL CARE RT ” Practice Location

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