Provider Demographics
NPI:1508994492
Name:HOMER, MINDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:
Last Name:HOMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COMMUNITY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3821
Mailing Address - Country:US
Mailing Address - Phone:516-869-9500
Mailing Address - Fax:516-869-9511
Practice Address - Street 1:800 COMMUNITY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3821
Practice Address - Country:US
Practice Address - Phone:516-869-9500
Practice Address - Fax:516-869-9511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0514481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry