Healthcare Provider Details

I. General information

NPI: 1750393112
Provider Name (Legal Business Name): MAMTA TALWAR SEHGAL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 JAMES L REDMAN PKWY STE 12
PLANT CITY FL
33566-9404
US

IV. Provider business mailing address

14722 HERONGLEN DR
LITHIA FL
33547-3867
US

V. Phone/Fax

Practice location:
  • Phone: 813-680-2407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: