Healthcare Provider Details

I. General information

NPI: 1497379325
Provider Name (Legal Business Name): POOJA MEHTA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2020
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 SHAW AVE STE 102
CLOVIS CA
93612-3963
US

IV. Provider business mailing address

382 N MCKELVY AVE APT 335
CLOVIS CA
93611-2414
US

V. Phone/Fax

Practice location:
  • Phone: 315-350-8795
  • Fax:
Mailing address:
  • Phone: 254-493-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number106974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: