Provider Demographics
NPI:1598887150
Name:MEHTA, MAYUR JAYANTILAL (DDS,MDPA)
Entity Type:Individual
Prefix:DR
First Name:MAYUR
Middle Name:JAYANTILAL
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DDS,MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 E LAKE RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2404
Mailing Address - Country:US
Mailing Address - Phone:727-785-7461
Mailing Address - Fax:727-786-1065
Practice Address - Street 1:3488 E LAKE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2404
Practice Address - Country:US
Practice Address - Phone:727-785-7461
Practice Address - Fax:727-786-1065
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00114891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice