Provider Demographics
NPI:1447769435
Name:MEHTA, TANVI
Entity Type:Individual
Prefix:DR
First Name:TANVI
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 S RIDGELAND AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-0020
Mailing Address - Country:US
Mailing Address - Phone:773-286-1500
Mailing Address - Fax:
Practice Address - Street 1:13303 S RIDGELAND AVE UNIT A
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-0020
Practice Address - Country:US
Practice Address - Phone:708-371-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist