Healthcare Provider Details

I. General information

NPI: 1255418588
Provider Name (Legal Business Name): TALYA MINTZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 SARNO RD
MELBOURNE FL
32935-3084
US

IV. Provider business mailing address

PO BOX 1137
MELBOURNE FL
32902-1137
US

V. Phone/Fax

Practice location:
  • Phone: 321-241-6800
  • Fax: 321-241-6890
Mailing address:
  • Phone: 713-320-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12200
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22572
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019026422
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6476015
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberHAD116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: