Provider Demographics
NPI:1750893236
Name:MEHTA, ANJALI SUDERSHAN KRISHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:SUDERSHAN KRISHAN
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N55W21136 LOGAN DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6277
Mailing Address - Country:US
Mailing Address - Phone:414-731-7848
Mailing Address - Fax:
Practice Address - Street 1:8001 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4507
Practice Address - Country:US
Practice Address - Phone:414-327-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001708-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist