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NPI Code Detail

MEDICARE: R MATTHEW MINER D.D.S.

MEDICARE: R MATTHEW MINER D.D.S.
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry11829MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111829OTHERDELTA DENTAL
2X05827OTHERDENTAL BLUE
3DMA502OTHERFIRST SENIORITY
40016777OTHERNEIGHBORHOOD HEALTH PLAN
516419OTHERHARVARD PILGRIM POS
616419OTHERHAVARD PILGRIM
716419OTHERHAVARD PILGRIM PPO

General Provider Information

NPI Number : 1609872233
Entity Type Code : Individual
Provider Name (Legal Business Name) : R MATTHEW MINER D.D.S.
Provider Business Mailing Address
First Line : PO BOX 9120
Second Line :
City : DEDHAM
State : MA
Zip : 02027-9120
Country : US
Telephone Number : 781-329-1400
Fax Number : 781-278-5667
Provider Business Practice Location Address
First Line : 1 LYONS ST
Second Line :
City : DEDHAM
State : MA
Zip : 02026-5599
Country : US
Telephone Number : 781-329-1400
Fax Number : 781-278-5667
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 07/08/2007

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