| Doctor Name: | MR. NATHANIEL STEVEN MINTER |
| NPI Number: | 1750655494 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DMD |
| License Number: | |
| Business Practice Address: | 208 W D L Ingram Blvd Bldg 1400 Cannon Afb, NM - 881035103 |
| Business Phone Number: | 8136796770 |
| Business Fax Number: | 5757844043 |
| Mailing Address: | 208 W D L Ingram Blvd, Bldg 1400 CANNON AFB |
| State: | NM |
| Postal Code: | 881035103 |
| Phone Number: | 5757844041 |
| Fax Number: | 5757844043 |
| NPI Enumeration Date: | 02/27/2012 |
| NPI Last Update Date: | 10/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |