Provider Demographics
NPI:1073647566
Name:ASHOK MEHTA, DDS
Entity Type:Organization
Organization Name:ASHOK MEHTA, DDS
Other - Org Name:IMPERIAL DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-671-9999
Mailing Address - Street 1:200 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4925
Mailing Address - Country:US
Mailing Address - Phone:714-671-9999
Mailing Address - Fax:714-671-0597
Practice Address - Street 1:200 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4925
Practice Address - Country:US
Practice Address - Phone:714-671-9999
Practice Address - Fax:714-671-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2876103Medicare ID - Type UnspecifiedMEDI-CAL DENTAL PROGRAM