Healthcare Provider Details

I. General information

NPI: 1124000807
Provider Name (Legal Business Name): FALGUNI V MEHTA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

894 EASTERN PKWY
BROOKLYN NY
11213-3618
US

IV. Provider business mailing address

592 ROCKAWAY AVE
BROOKLYN NY
11212-5539
US

V. Phone/Fax

Practice location:
  • Phone: 718-774-0724
  • Fax: 718-774-4426
Mailing address:
  • Phone: 718-345-5000
  • Fax: 718-345-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number039696
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: