Healthcare Provider Details

I. General information

NPI: 1992226328
Provider Name (Legal Business Name): YASH MEHTA DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 WASHINGTON BLVD #113 SUITE H 1
JESSUP MD
20794-8808
US

IV. Provider business mailing address

8150 WASHINGTON BLVD #113 SUITE H 1
JESSUP MD
20794-8808
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number14634
License Number StateMD

VIII. Authorized Official

Name: YASH MEHTA
Title or Position: PRESIDENT
Credential: DMD
Phone: 240-678-9342