Provider Demographics
NPI:1942211073
Name:MEHTA, DIPA NIRAV (DDS)
Entity Type:Individual
Prefix:MRS
First Name:DIPA
Middle Name:NIRAV
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:DIPA
Other - Middle Name:PRADYUMNA
Other - Last Name:BUTALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:895 E FREMONT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087
Mailing Address - Country:US
Mailing Address - Phone:408-732-0220
Mailing Address - Fax:408-469-4993
Practice Address - Street 1:895 E FREMONT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087
Practice Address - Country:US
Practice Address - Phone:408-732-0220
Practice Address - Fax:408-469-4993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist