Provider Demographics
NPI:1821127762
Name:MEHTA, SRISHTI (DDS)
Entity Type:Individual
Prefix:
First Name:SRISHTI
Middle Name:
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 1:5407 ABINGTON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4383
Mailing Address - Country:US
Mailing Address - Phone:405-208-9618
Mailing Address - Fax:
Practice Address - Street 1:7975 W GRAND PKWY S
Practice Address - Street 2:SUITE # 130
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8604
Practice Address - Country:US
Practice Address - Phone:281-201-2087
Practice Address - Fax:281-302-6890
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK752811162OtherFEDERAL TAX ID