Healthcare Provider Details

I. General information

NPI: 1740515113
Provider Name (Legal Business Name): DR ASHA MEHTA, DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 N. PARAMOUNT BLVD
LONG BEACH CA
90805
US

IV. Provider business mailing address

6950 N. PARAMOUNT BLVD
LONG BEACH CA
90805
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-9711
  • Fax: 562-251-2544
Mailing address:
  • Phone: 562-531-9711
  • Fax: 562-251-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29373
License Number StateCA

VIII. Authorized Official

Name: DR. ASHA M MEHTA
Title or Position: PRESIDENT
Credential: DDS. INC
Phone: 562-531-9711