Basic Information
| Provider Information | |||||||||
| NPI: | 1841245826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAO | ||||||||
| FirstName: | MINHTON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2867 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366522867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516908894 | ||||||||
| FaxNumber: | 2515442188 | ||||||||
| Practice Location | |||||||||
| Address1: | 3810 WULFF RD E | ||||||||
| Address2: | |||||||||
| City: | SEMMES | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365755256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514450582 | ||||||||
| FaxNumber: | 2514450584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 05/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | LNO5234 | AL | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 1063439065 | 01 | AL | GROUP PAYEE NPI NUMBER | OTHER | 631503053 | 05 | AL | MEDICAID | 011846 | 01 | AL | MEDICARE GROUP NUMBER | OTHER |