MEDICARE: MARCUS MINER DDS,MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DD2973	NM

General Provider Information

NPI Number	:	1194886457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS MINER DDS,MS

Provider Business Mailing Address
First Line	:	2918 HILLRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4702
Country	:	US
Telephone Number	:	575-522-1760
Fax Number	:	575-522-8810

Provider Business Practice Location Address
First Line	:	2918 HILLRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4702
Country	:	US
Telephone Number	:	575-522-1760
Fax Number	:	575-522-8810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	04/14/2008

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