Provider Demographics
NPI:1043557705
Name:MEHTA, BIJAL ASHOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BIJAL
Middle Name:ASHOK
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 LOS ALAMITOS BLVD STE 133
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5612
Mailing Address - Country:US
Mailing Address - Phone:562-596-8888
Mailing Address - Fax:562-596-8178
Practice Address - Street 1:10900 LOS ALAMITOS BLVD STE 133
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5612
Practice Address - Country:US
Practice Address - Phone:562-596-8888
Practice Address - Fax:562-596-8178
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist