Provider Demographics
NPI:1164762159
Name:PARUL MEHTA DENTAL CORP
Entity Type:Organization
Organization Name:PARUL MEHTA DENTAL CORP
Other - Org Name:RIVERSIDE DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARUL
Authorized Official - Middle Name:U
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-539-5556
Mailing Address - Street 1:1485 UNIVERSITY AVE
Mailing Address - Street 2:A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-9500
Mailing Address - Country:US
Mailing Address - Phone:951-784-4441
Mailing Address - Fax:951-784-4030
Practice Address - Street 1:1485 UNIVERSITY AVE
Practice Address - Street 2:A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-9500
Practice Address - Country:US
Practice Address - Phone:951-784-4441
Practice Address - Fax:951-784-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty