Provider Demographics
NPI:1275728651
Name:MEHROTRA, POOJA (DDS)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:
Last Name:MEHROTRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:POOJA
Other - Middle Name:
Other - Last Name:GANDHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8285 W UNION HILLS DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0510
Mailing Address - Country:US
Mailing Address - Phone:646-527-5611
Mailing Address - Fax:
Practice Address - Street 1:8285 W UNION HILLS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0510
Practice Address - Country:US
Practice Address - Phone:646-527-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDN008573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist