Healthcare Provider Details

I. General information

NPI: 1154635787
Provider Name (Legal Business Name): YASH MEHTA D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 WASHINGTON BLVD STE 113A
JESSUP MD
20794-8815
US

IV. Provider business mailing address

11039 BIRCHTREE LANE
LAUREL MD
20723
US

V. Phone/Fax

Practice location:
  • Phone: 240-678-9342
  • Fax:
Mailing address:
  • Phone: 240-678-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14634
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: