Provider Demographics
NPI:1285862854
Name:NATHA, HETAL MAHENDRA
Entity Type:Individual
Prefix:
First Name:HETAL
Middle Name:MAHENDRA
Last Name:NATHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HETALBEN
Other - Middle Name:MAHENDRA
Other - Last Name:NATHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:2712 E ABRAM ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-1437
Mailing Address - Country:US
Mailing Address - Phone:512-789-7564
Mailing Address - Fax:
Practice Address - Street 1:8608 PRESTON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3316
Practice Address - Country:US
Practice Address - Phone:888-749-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15593124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist