Provider Demographics
NPI:1518149236
Name:NIRAV MEHTA DENTAL CORPORATION
Entity Type:Organization
Organization Name:NIRAV MEHTA DENTAL CORPORATION
Other - Org Name:ORAL HEATH CARE OF SOUTHERN CALIFORNIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:800-719-6107
Mailing Address - Street 1:2408 CORONET BLVD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1625
Mailing Address - Country:US
Mailing Address - Phone:800-719-6107
Mailing Address - Fax:
Practice Address - Street 1:2408 CORONET BLVD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1625
Practice Address - Country:US
Practice Address - Phone:800-719-6107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty