MEDICARE: DR. DAVID PHILLIP 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
1	122300000X	Dentist	DS020905L	PA

General Provider Information

NPI Number	:	1982747135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PHILLIP MINER D.D.S.

Provider Business Mailing Address
First Line	:	1002 HENRIETTA AVE
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-8504
Country	:	US
Telephone Number	:	215-663-8836
Fax Number	:	215-663-5639

Provider Business Practice Location Address
First Line	:	6936 SYLVESTER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1821
Country	:	US
Telephone Number	:	215-342-2538
Fax Number	:	215-663-5639

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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