Provider Demographics
NPI:1740624121
Name:MEHROTRA, PRAKHAR (DDS, MD)
Entity type:Individual
Prefix:
First Name:PRAKHAR
Middle Name:
Last Name:MEHROTRA
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MORRISTOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1657
Mailing Address - Country:US
Mailing Address - Phone:908-395-0111
Mailing Address - Fax:908-395-0108
Practice Address - Street 1:175 MORRISTOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1657
Practice Address - Country:US
Practice Address - Phone:908-395-0111
Practice Address - Fax:908-395-0108
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027300001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery