Provider Demographics
NPI:1720208671
Name:SATA, MEGHA (DDS)
Entity Type:Individual
Prefix:
First Name:MEGHA
Middle Name:
Last Name:SATA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 15TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3562
Mailing Address - Country:US
Mailing Address - Phone:734-972-7003
Mailing Address - Fax:
Practice Address - Street 1:410 CAMINO REAL
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3815
Practice Address - Country:US
Practice Address - Phone:310-316-1212
Practice Address - Fax:310-316-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555231223G0001X
MI53150258481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice