Provider Demographics
NPI:1891274205
Name:MEHTA, MANALI
Entity Type:Individual
Prefix:
First Name:MANALI
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37000 MEADOWBROOK CMN APT 101
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-7428
Mailing Address - Country:US
Mailing Address - Phone:585-967-5763
Mailing Address - Fax:
Practice Address - Street 1:8105 EDGEWATER DR STE 250
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2017
Practice Address - Country:US
Practice Address - Phone:510-568-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADD102973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist