Provider Demographics
NPI:1295153971
Name:MEHRA, SUMEDHA
Entity type:Individual
Prefix:
First Name:SUMEDHA
Middle Name:
Last Name:MEHRA
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 1:4750 TASSAJARA RD
Mailing Address - Street 2:APT 5209
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4565
Mailing Address - Country:US
Mailing Address - Phone:510-579-3110
Mailing Address - Fax:
Practice Address - Street 1:4750 TASSAJARA RD
Practice Address - Street 2:APT 5209
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4565
Practice Address - Country:US
Practice Address - Phone:510-579-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH27444124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist