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NPI Code Detail

MEDICARE: KIMBERLY JOI MINOR DDS

MEDICARE: KIMBERLY JOI MINOR 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
11223G0001XGeneral Practice Dentistry7639NC

General Provider Information

NPI Number : 1902918444
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY JOI MINOR DDS
Provider Business Mailing Address
First Line : 4901 N TRYON ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28213-7033
Country : US
Telephone Number : 704-921-0204
Fax Number : 704-921-4095
Provider Business Practice Location Address
First Line : 4901 N TRYON ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28213-7033
Country : US
Telephone Number : 704-921-0204
Fax Number : 704-921-4095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 03/27/2008

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Directions to “ KIMBERLY JOI MINOR DDS” Practice Location

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