Healthcare Provider Details

I. General information

NPI: 1265002893
Provider Name (Legal Business Name): PRARTHIT HEMENDRAKUMAR MEHTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W FOOTHILL BLVD
RIALTO CA
92376-5048
US

IV. Provider business mailing address

24929 PROSPECT AVE
LOMA LINDA CA
92354-2811
US

V. Phone/Fax

Practice location:
  • Phone: 909-546-7064
  • Fax:
Mailing address:
  • Phone: 310-228-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number106308
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDB-2025-0113
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: