Healthcare Provider Details

I. General information

NPI: 1659313625
Provider Name (Legal Business Name): MILLARD EUGENE MINOR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 N MAIN ST OFFICE 2 AND 3
PHILIPPI WV
26416-1155
US

IV. Provider business mailing address

27 N MAIN ST OFFICE 2 AND 3
PHILIPPI WV
26416-1155
US

V. Phone/Fax

Practice location:
  • Phone: 304-457-2015
  • Fax:
Mailing address:
  • Phone: 304-457-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberWV 2063
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: