Healthcare Provider Details

I. General information

NPI: 1477249985
Provider Name (Legal Business Name): SUHAN MESTHA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 GRAND CONCOURSE FL 6
BRONX NY
10453-8202
US

IV. Provider business mailing address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8400
  • Fax:
Mailing address:
  • Phone: 718-250-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number064029
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number064029
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: