Provider Demographics
NPI:1750031423
Name:MEHTA, ANUJ (DDS)
Entity Type:Individual
Prefix:
First Name:ANUJ
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 MARIPOSA DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-6408
Mailing Address - Country:US
Mailing Address - Phone:530-713-1597
Mailing Address - Fax:
Practice Address - Street 1:1185 MARIPOSA DR
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-6408
Practice Address - Country:US
Practice Address - Phone:530-713-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1073581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107358OtherDENTAL LISENCE