Provider Demographics
NPI:1245802842
Name:MEHTA, AJAY
Entity Type:Individual
Prefix:MR
First Name:AJAY
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 RIDGE GATE DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7801
Mailing Address - Country:US
Mailing Address - Phone:650-666-9977
Mailing Address - Fax:
Practice Address - Street 1:160 HOLIDAY PL
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2622
Practice Address - Country:US
Practice Address - Phone:317-736-0232
Practice Address - Fax:463-224-8269
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013651A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty