Provider Demographics
NPI:1952538399
Name:PARIKH, MITA AMRISH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITA
Middle Name:AMRISH
Last Name:PARIKH
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 1:136 WOODBURY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1411
Mailing Address - Country:US
Mailing Address - Phone:516-367-4003
Mailing Address - Fax:
Practice Address - Street 1:136 WOODBURY RD STE 102
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1411
Practice Address - Country:US
Practice Address - Phone:516-367-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 0534001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics