Provider Demographics
NPI:1669684767
Name:MEHTA, TARAL TUSHAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARAL
Middle Name:TUSHAR
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SECRETARIAT CIR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5261
Mailing Address - Country:US
Mailing Address - Phone:215-233-5811
Mailing Address - Fax:
Practice Address - Street 1:1811 BETHLEHEM PIKE
Practice Address - Street 2:SUITE A-102
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1111
Practice Address - Country:US
Practice Address - Phone:215-233-5811
Practice Address - Fax:215-233-5799
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0354021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice