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NPI Code Detail

MEDICARE: DR. JAMES J MINTA D.D.S.

MEDICARE: DR. JAMES J MINTA D.D.S.
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
1122300000XDentist9679FL

General Provider Information

NPI Number : 1952561524
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES J MINTA D.D.S.
Provider Business Mailing Address
First Line : 2324 POST ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-3622
Country : US
Telephone Number : 904-387-0405
Fax Number : 904-387-5107
Provider Business Practice Location Address
First Line : 2324 POST ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-3622
Country : US
Telephone Number : 904-387-0405
Fax Number : 904-387-5107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2008
Last Update Date : 06/16/2008

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