Provider Demographics
NPI:1952049074
Name:DENTISTRY OF THE PONDS P.L.L.C.
Entity Type:Organization
Organization Name:DENTISTRY OF THE PONDS P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-360-4413
Mailing Address - Street 1:12511 PORTLAND AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-7508
Mailing Address - Country:US
Mailing Address - Phone:865-360-4413
Mailing Address - Fax:
Practice Address - Street 1:436 POND PROMENADE
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-8307
Practice Address - Country:US
Practice Address - Phone:952-906-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty