Active NPI
Talya Mintz, DDS
- General Practice Dentistry
- Melbourne, FL
National Provider Identifier
1255418588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- HAD116
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113689800 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160321000813 | TX | Order and Referring Only - Dentist | 3476850389 | |
| I20220510002202 | FL | Order and Referring Only - Dentist | 3476850389 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019026422 | IL | MD | Dentist |
| D12200 | MN | MD | Dentist |
| 22572 | TX | MD | Dentist |
| 6476015 | WI | MD | Dentist |
| 22527 | TX | MD | Pharmacist |
Interoperability endpoints
- 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.