Provider Demographics
NPI:1104263177
Name:IN HOME DENTAL CARE,PLLC
Entity type:Organization
Organization Name:IN HOME DENTAL CARE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-986-0744
Mailing Address - Street 1:5262 S STAPLES ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4116
Mailing Address - Country:US
Mailing Address - Phone:361-986-0744
Mailing Address - Fax:866-610-1808
Practice Address - Street 1:5262 S STAPLES ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4116
Practice Address - Country:US
Practice Address - Phone:361-986-0744
Practice Address - Fax:866-610-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty