Provider Demographics
NPI:1609055532
Name:MEHTA, RAVIN S (BDS)
Entity Type:Individual
Prefix:DR
First Name:RAVIN
Middle Name:S
Last Name:MEHTA
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3796 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-4122
Mailing Address - Country:US
Mailing Address - Phone:954-739-1430
Mailing Address - Fax:954-318-1931
Practice Address - Street 1:3796 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-4122
Practice Address - Country:US
Practice Address - Phone:954-739-1430
Practice Address - Fax:954-318-1931
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist