Provider Demographics
NPI:1700816022
Name:NOMITA MEHTA DDS PLLC
Entity Type:Organization
Organization Name:NOMITA MEHTA DDS PLLC
Other - Org Name:28TH AVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NOMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-576-0600
Mailing Address - Street 1:2802 W NOB HILL BLVD # A
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4982
Mailing Address - Country:US
Mailing Address - Phone:509-576-0600
Mailing Address - Fax:509-576-0602
Practice Address - Street 1:2802 W NOB HILL BLVD # A
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4982
Practice Address - Country:US
Practice Address - Phone:509-576-0600
Practice Address - Fax:509-576-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental