Provider Demographics
NPI:1750424677
Name:MINOLI, GUY NICHOLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:NICHOLAS
Last Name:MINOLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTHWAY
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4303
Mailing Address - Country:US
Mailing Address - Phone:914-771-9533
Mailing Address - Fax:
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:SUITE 5 E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8183
Practice Address - Country:US
Practice Address - Phone:212-888-4140
Practice Address - Fax:212-486-7556
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT81211Medicare UPIN