Provider Demographics
NPI:1972692499
Name:RINA M. MEHTA, DMD, PC
Entity Type:Organization
Organization Name:RINA M. MEHTA, DMD, PC
Other - Org Name:VILLAGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-428-2888
Mailing Address - Street 1:2500 DALLAS HWY SW
Mailing Address - Street 2:SUITE #401
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2567
Mailing Address - Country:US
Mailing Address - Phone:770-428-4888
Mailing Address - Fax:770-428-4009
Practice Address - Street 1:2500 DALLAS HWY SW
Practice Address - Street 2:SUITE #401
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2567
Practice Address - Country:US
Practice Address - Phone:770-428-4888
Practice Address - Fax:770-428-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherS CORPORATION