Provider Demographics
NPI:1003941881
Name:MAHENDRAKUMAR MEHTA DDS INC
Entity Type:Organization
Organization Name:MAHENDRAKUMAR MEHTA DDS INC
Other - Org Name:DR. MEHTA'S GROVE DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHENDRAKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:909-596-7700
Mailing Address - Street 1:3167 N. GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-596-7700
Mailing Address - Fax:909-392-4697
Practice Address - Street 1:3167 N. GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-596-7700
Practice Address - Fax:909-392-4697
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAHENDRAKUMAR MEHTA DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-22
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293731223X0400X
1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty