Individual
DR. MARK M. MINIUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1412 BRIDGE ST, NEW CUMBERLAND, PA 17070-1117
(717) 774-1200
(717) 774-2568
Mailing address
1412 BRIDGE ST, NEW CUMBERLAND, PA 17070-1117
(717) 774-1200
(717) 774-2568
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS020106L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI279056
UNITED CONCORDIA PROV. #
PA
Enumeration date
03/08/2007
Last updated
07/08/2007
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