Provider Demographics
NPI:1619399649
Name:MEHTA DENTAL GROUP
Entity Type:Organization
Organization Name:MEHTA DENTAL GROUP
Other - Org Name:GRINS & SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-643-7547
Mailing Address - Street 1:3730 KIRBY DR STE 401
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3930
Mailing Address - Country:US
Mailing Address - Phone:713-561-5635
Mailing Address - Fax:
Practice Address - Street 1:3730 KIRBY DR STE 401
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3930
Practice Address - Country:US
Practice Address - Phone:713-561-5635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty