Provider Demographics
NPI:1558494310
Name:ASHOK MEHTA, DDS, INC
Entity Type:Organization
Organization Name:ASHOK MEHTA, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-928-4299
Mailing Address - Street 1:10900 LOS ALAMITOS BLVD STE 133
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5612
Mailing Address - Country:US
Mailing Address - Phone:562-596-8888
Mailing Address - Fax:562-596-8178
Practice Address - Street 1:10900 LOS ALAMITOS BLVD STE 133
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5612
Practice Address - Country:US
Practice Address - Phone:562-596-8888
Practice Address - Fax:562-596-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB28761Medicare ID - Type UnspecifiedMEDI-CAL DENTAL PROGRAM