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General NPI Number Information
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NPI Number | 1750470068
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN MINER D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 130 PIONEER TRL
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City | CHASKA
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State | MN
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Zip | 55318-1167
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Country | US
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Telephone | 952-361-3740
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 SUNNYBROOK CIR
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City | MINNETRISTA
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State | MN
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Zip | 55364-1276
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Country | US
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Telephone | 612-387-5009
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Fax | 612-392-7915
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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 | D11974
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License Number State | MN
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