Provider Demographics
NPI:1952533689
Name:MEHRA, KAAJAL
Entity Type:Individual
Prefix:
First Name:KAAJAL
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:PO BOX 1168
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1168
Mailing Address - Country:US
Mailing Address - Phone:256-741-7340
Mailing Address - Fax:
Practice Address - Street 1:4323 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2706
Practice Address - Country:US
Practice Address - Phone:214-522-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24715OtherTEXAS DENTAL LICENSE
TX207472605Medicaid