Provider Demographics
NPI:1922342203
Name:SALIL MEHTA DMD PC
Entity Type:Organization
Organization Name:SALIL MEHTA DMD PC
Other - Org Name:FRESH DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-390-5063
Mailing Address - Street 1:3409 N TARRANT PKWY
Mailing Address - Street 2:117
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8607
Mailing Address - Country:US
Mailing Address - Phone:817-337-8833
Mailing Address - Fax:
Practice Address - Street 1:3409 N TARRANT PKWY
Practice Address - Street 2:SUITE 117
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8607
Practice Address - Country:US
Practice Address - Phone:817-337-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty