Provider Demographics
NPI:1659060044
Name:MEHTA, SANJNA SAMIR (DMD)
Entity Type:Individual
Prefix:
First Name:SANJNA
Middle Name:SAMIR
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4744 12TH AVE NE APT 512
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4695
Mailing Address - Country:US
Mailing Address - Phone:484-340-8240
Mailing Address - Fax:
Practice Address - Street 1:1732 BROADWAY UNIT 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2621
Practice Address - Country:US
Practice Address - Phone:484-340-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61416718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist