Minto Oral & Maxillofacial Surgery, LLC

Contacts

Phone	+1 251-990-5959
Fax	5213789032

Authorized person

Name	DR. DAVID GORDON MINTO JR.
Role	OWNER
Phone	2519905959

Taxonomy

Taxonomy Code	1223S0112X - Oral and Maxillofacial Surgery (Dentist)
License Number	6381
State	AL
Is Primary	Yes

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2519905959
Plan sponsor’s address	19748 S GREENO RD, FAIRHOPE, AL, 36532

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2519905959
Plan sponsor’s address	19748 S GREENO RD, FAIRHOPE, AL, 36532

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2519905959
Plan sponsor’s address	19748 S GREENO RD, FAIRHOPE, AL, 36532

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2519905959
Plan sponsor’s address	19748 S GREENO RD, FAIRHOPE, AL, 36532

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2519905959
Plan sponsor’s address	19748 S GREENO RD, FAIRHOPE, AL, 36532

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2018-01-01
Business code	621210
Sponsor’s telephone number	2519905959
Plan sponsor’s address	19748 S GREENO RD, FAIRHOPE, AL, 36532

Signature of

Role	Plan administrator
Date	2019-10-02
Name of individual signing	DAVID MINTO