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General NPI Number Information
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NPI Number | 1104263177
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Entity Type | Organization
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Legal Business Name | IN HOME DENTAL CARE,PLLC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 5262 S STAPLES ST SUITE 300
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-4116
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Country | US
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Telephone | 361-986-0744
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Fax | 866-610-1808
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Provider Business Mailing Address
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Address Line | 5262 S STAPLES ST SUITE 300
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-4116
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Country | US
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Telephone | 361-986-0744
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Fax | 866-610-1808
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TALYA MINTZ
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Credential | DDS
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Telephone | 361-986-0744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22527
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License Number State | TX
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