Provider Demographics
NPI:1811596307
Name:MEHTA, KINJAL J (DMD)
Entity Type:Individual
Prefix:
First Name:KINJAL
Middle Name:J
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30G GARDEN TER
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-8206
Mailing Address - Country:US
Mailing Address - Phone:201-539-0923
Mailing Address - Fax:
Practice Address - Street 1:151 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2490
Practice Address - Country:US
Practice Address - Phone:908-409-3094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028147001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice