MEDICARE: DR. MARK ALAN MINCHOW DDS

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	122300000X	Dentist	5918	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285623330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALAN MINCHOW DDS

Provider Business Mailing Address
First Line	:	306 S 4TH ST
Second Line	:	SUITE 100
City	:	SEWARD
State	:	NE
Zip	:	68434
Country	:	US
Telephone Number	:	402-643-2931
Fax Number	:	402-643-4258

Provider Business Practice Location Address
First Line	:	306 S 4TH ST
Second Line	:	SUITE 100
City	:	SEWARD
State	:	NE
Zip	:	68434
Country	:	US
Telephone Number	:	402-643-2931
Fax Number	:	402-643-4258

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/28/2022

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Directions to “ DR. MARK ALAN MINCHOW DDS” Practice Location

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