Healthcare Provider Details

I. General information

NPI: 1942098116
Provider Name (Legal Business Name): ADITYA MEHRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 ORCHARD ST
RAYNHAM MA
02767-1342
US

IV. Provider business mailing address

4 SNOWBERRY CT
MILLER PLACE NY
11764-3052
US

V. Phone/Fax

Practice location:
  • Phone: 774-619-7683
  • Fax:
Mailing address:
  • Phone: 516-234-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10000970
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: