Provider Demographics
NPI:1871085787
Name:JEFFREY G. MINCHAU, DDS, MS, INC.
Entity type:Organization
Organization Name:JEFFREY G. MINCHAU, DDS, MS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MINCHAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:304-594-1670
Mailing Address - Street 1:9000 COOMBS FARM DR.
Mailing Address - Street 2:STE. 304
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508
Mailing Address - Country:US
Mailing Address - Phone:304-594-1670
Mailing Address - Fax:304-594-1671
Practice Address - Street 1:2601 DUDLEY AVENUE
Practice Address - Street 2:BLDG. 1
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101
Practice Address - Country:US
Practice Address - Phone:304-485-4600
Practice Address - Fax:304-485-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28051223E0200X
WV37791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty