Provider Demographics
NPI:1790354181
Name:MEHTA, MONIL JATIN (DMD)
Entity Type:Individual
Prefix:
First Name:MONIL
Middle Name:JATIN
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 1:20700 CHIPPENDALE AVE
Mailing Address - Street 2:UNIT 10
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024
Mailing Address - Country:US
Mailing Address - Phone:651-315-8229
Mailing Address - Fax:
Practice Address - Street 1:20700 CHIPPENDALE AVE
Practice Address - Street 2:UNIT 10
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024
Practice Address - Country:US
Practice Address - Phone:651-315-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND146011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice