Provider Demographics
NPI:1912918939
Name:MEHTA, ASHA M (MDS)
Entity Type:Individual
Prefix:DR
First Name:ASHA
Middle Name:M
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1366
Mailing Address - Country:US
Mailing Address - Phone:909-596-7700
Mailing Address - Fax:
Practice Address - Street 1:3167 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1366
Practice Address - Country:US
Practice Address - Phone:909-596-7700
Practice Address - Fax:909-392-4697
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics