MEDICARE: NIYATI NIKHIL MEHTA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1588957914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIYATI NIKHIL MEHTA DDS

Provider Business Mailing Address
First Line	:	4004 HIDDEN CANYON CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-1260
Country	:	US
Telephone Number	:	512-797-7693
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 HIDDEN CANYON CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-1260
Country	:	US
Telephone Number	:	512-797-7693
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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