Healthcare Provider Details

I. General information

NPI: 1932866183
Provider Name (Legal Business Name): ASHOKKUMAR S. MEHTA D.D.S, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N STATE COLLEGE BLVD 105
ANAHEIM CA
92806
US

IV. Provider business mailing address

330 N STATE COLLEGE BLVD 105
ANAHEIM CA
92806
US

V. Phone/Fax

Practice location:
  • Phone: 714-772-5005
  • Fax:
Mailing address:
  • Phone: 714-772-5005
  • Fax: 714-772-6942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MR. ASHOKKUMAR SHANTILAL MEHTA
Title or Position: D.D.S/OWNER
Credential: D.D.S
Phone: 714-928-4299