Robert Glenn McMinn, DDS MSD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D-1435-OR Issued in ID

Practice address

1133 Call Creek Dr.
Pocatello, ID 83201

Phone

(208) 232-0464

Fax

(208) 232-0863

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457570921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2061 SUNRISE WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832011985",
            "telephone_number": "208-237-0129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 CALL CREEK DR.",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83201",
            "telephone_number": "208-232-0464",
            "fax_number": "208-232-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMINN",
        "first_name": "ROBERT",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "DDS  MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "D-1435-OR",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew L McKinlay, PA-C
• Theresa Lynn McKinney, D.D.S.
• Maja Page McKnight, M.T.
• Holly C McLain, LCSW
• Jeffrey T McMinn, D.M.D.
• Vanessa McNabb
• Brooke Nicole McNeel
• Andrew W McRoberts, M.D.
• Robert Daniel McWhorter, DDS
• Meadowland Therapy Inc

• Orthodontics and Dentofacial Orthopedics Dentistry in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.