Provider Demographics
NPI:1760498448
Name:MINER, LINDA LOU (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LOU
Last Name:MINER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 W I 240 SERVICE RD STE D
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2134
Mailing Address - Country:US
Mailing Address - Phone:405-631-3877
Mailing Address - Fax:405-631-7414
Practice Address - Street 1:1145 W I 240 SERVICE RD STE D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2134
Practice Address - Country:US
Practice Address - Phone:405-631-3877
Practice Address - Fax:405-631-7414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice