Provider Demographics
NPI:1982615910
Name:MEHTA, MAHENDRAKUMAR V (BDS)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRAKUMAR
Middle Name:V
Last Name:MEHTA
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4576 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2430
Mailing Address - Country:US
Mailing Address - Phone:323-261-0369
Mailing Address - Fax:323-269-1920
Practice Address - Street 1:4576 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2430
Practice Address - Country:US
Practice Address - Phone:323-261-0369
Practice Address - Fax:323-269-1920
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
CA285971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice