Provider Demographics
NPI:1548394034
Name:ASHOK S.MEHTA, DDS,INC
Entity Type:Organization
Organization Name:ASHOK S.MEHTA, DDS,INC
Other - Org Name:SOUTHLAND DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOKKUMAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-838-3230
Mailing Address - Street 1:740 EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4369
Mailing Address - Country:US
Mailing Address - Phone:714-838-3230
Mailing Address - Fax:714-838-0253
Practice Address - Street 1:740 EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4369
Practice Address - Country:US
Practice Address - Phone:714-838-3230
Practice Address - Fax:714-838-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty