Healthcare Provider Details

I. General information

NPI: 1467316133
Provider Name (Legal Business Name): MINTON FAMILY DENTAL CARE RT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CEDAR FORK RD
TAZEWELL TN
37879-3201
US

IV. Provider business mailing address

210 CEDAR FORK RD
TAZEWELL TN
37879-3201
US

V. Phone/Fax

Practice location:
  • Phone: 360-513-5328
  • Fax:
Mailing address:
  • Phone: 360-513-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: KEARSTIN STALLINGS
Title or Position: CEO
Credential:
Phone: 360-513-5328