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General NPI Number Information
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NPI Number | 1649707514
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Entity Type | Organization
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Legal Business Name | MINTO ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 19748 GREENO RD
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City | FAIRHOPE
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State | AL
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Zip | 36532-3836
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Country | US
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Telephone | 251-990-5959
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Fax | 521-378-9032
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Provider Business Mailing Address
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Address Line | 19748 GREENO RD
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City | FAIRHOPE
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State | AL
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Zip | 36532-3836
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Country | US
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Telephone |
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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. DAVID GORDON MINTO JR.
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Credential | DMD, MD
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Telephone | 251-990-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 6381
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License Number State | AL
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