Individual provider Active NPI

Talya Mintz, DDS

  • General Practice Dentistry
  • Melbourne, FL
National Provider Identifier
1255418588
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
HAD116 Issued in FL
Practice address
2120 Sarno Rd
Melbourne, FL 32935-3084
Phone
(321) 241-6800
Fax
(321) 241-6890
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D12200 MN
Dentist 122300000X 22572 TX
Dentist 122300000X 019026422 IL
Dentist 122300000X 6476015 WI
General Practice Dentistry 1223G0001X HAD116 FL Primary

Addresses

Primary practice location

2120 Sarno Rd
Melbourne, FL 32935-3084

Mailing address

PO Box 1137
Melbourne, FL 32902-1137
Phone (713) 320-6365

Other identifiers 1

IdentifierTypeStateIssuer
113689800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160321000813 TX Order and Referring Only - DentistPractitioner - Dentist 3476850389
I20220510002202 FL Order and Referring Only - DentistPractitioner - Dentist 3476850389

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019026422ILMDDentist
D12200MNMDDentist
22572TXMDDentist
6476015WIMDDentist
22527TXMDPharmacist

Interoperability endpoints

  • Direct secure messaging: talya.mintz@bha.eclinicaldirectplus.com

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1255418588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1137",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329021137",
            "telephone_number": "713-320-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 SARNO RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353084",
            "telephone_number": "321-241-6800",
            "fax_number": "321-241-6890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINTZ",
        "first_name": "TALYA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12200",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "22572",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026422",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6476015",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "HAD116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113689800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.