Provider Demographics
NPI:1508934951
Name:MEHTA, DHAVAL TUSHAR (DMD)
Entity Type:Individual
Prefix:
First Name:DHAVAL
Middle Name:TUSHAR
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 FARM VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-2445
Mailing Address - Country:US
Mailing Address - Phone:610-998-9540
Mailing Address - Fax:215-472-4009
Practice Address - Street 1:17 S. 60TH ST. 2ND FLR.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139
Practice Address - Country:US
Practice Address - Phone:215-472-4500
Practice Address - Fax:215-472-4009
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029462L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015608700003Medicaid