Healthcare Provider Details

I. General information

NPI: 1346362399
Provider Name (Legal Business Name): SCOTT GEORGE MINNICH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 ERINDALE DR SUITE 200
COLORADO SPRINGS CO
80918-8926
US

IV. Provider business mailing address

5745 ERINDALE DR SUITE 200
COLORADO SPRINGS CO
80918-8926
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-7665
  • Fax: 719-599-8599
Mailing address:
  • Phone: 719-599-7665
  • Fax: 719-599-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number104149
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: