Individual
DR. MARK RICHARD MINICHELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2606 CAUGHEY RD, ERIE, PA 16506-2148
(814) 833-4393
(814) 838-0781
Mailing address
2606 CAUGHEY RD, ERIE, PA 16506-2148
(814) 833-4393
(814) 838-0781
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS027249L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
608515
UNITED CONCORDIA PROVIDER
PA
Enumeration date
10/17/2006
Last updated
07/08/2007
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