Provider Demographics
NPI:1609449305
Name:MINGS, MICHAEL CHASE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHASE
Last Name:MINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FILER AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4708
Mailing Address - Country:US
Mailing Address - Phone:208-320-3198
Mailing Address - Fax:
Practice Address - Street 1:105 FILER AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4708
Practice Address - Country:US
Practice Address - Phone:208-944-9057
Practice Address - Fax:208-944-9146
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLD-128122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist