Provider Demographics
NPI:1952661258
Name:MEENA H. MEHTA
Entity Type:Organization
Organization Name:MEENA H. MEHTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEENA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-491-1138
Mailing Address - Street 1:3981 LAWRENCEVILLE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4525
Mailing Address - Country:US
Mailing Address - Phone:770-491-1138
Mailing Address - Fax:770-491-1168
Practice Address - Street 1:3981 LAWRENCEVILLE HWY STE A
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4525
Practice Address - Country:US
Practice Address - Phone:770-491-1138
Practice Address - Fax:770-491-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000362964EMedicaid