Provider Demographics
NPI:1518480599
Name:MEHTA, NISHIT KAUSHIK (DDS)
Entity Type:Individual
Prefix:
First Name:NISHIT
Middle Name:KAUSHIK
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 PARK PLACE LN APT 313
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-5220
Mailing Address - Country:US
Mailing Address - Phone:213-298-9652
Mailing Address - Fax:
Practice Address - Street 1:1260 MILTON AVE STE 140
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1890
Practice Address - Country:US
Practice Address - Phone:608-757-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001555-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist