Healthcare Provider Details

I. General information

NPI: 1285543025
Provider Name (Legal Business Name): CHETAN K MEHTA DMD MSD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13372 NEWPORT AVE STE C
TUSTIN CA
92780-3426
US

IV. Provider business mailing address

13372 NEWPORT AVE STE C
TUSTIN CA
92780-3426
US

V. Phone/Fax

Practice location:
  • Phone: 714-838-1238
  • Fax: 714-838-9586
Mailing address:
  • Phone: 714-838-1238
  • Fax: 714-838-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MICHAELA MUNIZ
Title or Position: VP, PAYOR RELATIONS
Credential:
Phone: 469-324-3242