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General NPI Number Information
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NPI Number | 1487930384
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Entity Type | Individual
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Provider Name | SCOTT JAMES MINNICH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 8201 N CROSWELL RD
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City | SAINT LOUIS
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State | MI
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Zip | 48880-9210
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Country | US
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Telephone | 989-681-4362
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Fax |
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Provider Business Mailing Address
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Address Line | 8201 N CROSWELL RD
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City | SAINT LOUIS
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State | MI
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Zip | 48880-9210
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Country | US
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Telephone | 989-681-4362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901015172
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License Number State | MI
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