Provider Demographics
NPI:1528179074
Name:MEHTA, KALPESH (DMD)
Entity Type:Individual
Prefix:
First Name:KALPESH
Middle Name:
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 1:1301 S INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 2041
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1409
Mailing Address - Country:US
Mailing Address - Phone:407-829-2123
Mailing Address - Fax:
Practice Address - Street 1:1301 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2041
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1409
Practice Address - Country:US
Practice Address - Phone:407-829-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice