Provider Demographics
NPI:1275640963
Name:MEHTA, KRISHNAKAMAL C (BDS)
Entity Type:Individual
Prefix:
First Name:KRISHNAKAMAL
Middle Name:C
Last Name:MEHTA
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-8047
Mailing Address - Country:US
Mailing Address - Phone:915-235-1178
Mailing Address - Fax:
Practice Address - Street 1:3641 CONNALLY DR
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7972
Practice Address - Country:US
Practice Address - Phone:321-634-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL109531223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health