Provider Demographics
NPI:1841578085
Name:MEHTA, VAIDEHI J (DMD)
Entity Type:Individual
Prefix:DR
First Name:VAIDEHI
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 1:13037 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1960
Mailing Address - Country:US
Mailing Address - Phone:210-654-8109
Mailing Address - Fax:210-654-0034
Practice Address - Street 1:13037 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1960
Practice Address - Country:US
Practice Address - Phone:210-654-8109
Practice Address - Fax:210-654-0034
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD151511223G0001X
PADS0388231223G0001X
TX317071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice