Provider Demographics
NPI:1760097489
Name:MEHTA, POOJA DEEPAKBHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:DEEPAKBHAI
Last Name:MEHTA
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 1:39430 CIVIC CENTER DR APT 511
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6706
Mailing Address - Country:US
Mailing Address - Phone:682-706-8002
Mailing Address - Fax:
Practice Address - Street 1:2503 BELL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2533
Practice Address - Country:US
Practice Address - Phone:503-823-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist