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General NPI Number Information
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NPI Number | 1134580939
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Entity Type | Organization
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Legal Business Name | MICHAEL D. MINNICH, DDS, MS, INC
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 713 SEAGAZE DR
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City | OCEANSIDE
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State | CA
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Zip | 92054-3006
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Country | US
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Telephone | 760-721-1552
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Fax |
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Provider Business Mailing Address
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Address Line | 713 SEAGAZE DR
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City | OCEANSIDE
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State | CA
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Zip | 92054-3006
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Country | US
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Telephone | 760-721-1552
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL DAVID MINNICH
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Credential | DDS, MS
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Telephone | 760-721-1552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 35432
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License Number State | CA
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