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General NPI Number Information
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NPI Number | 1275640963
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Entity Type | Individual
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Provider Name | KRISHNAKAMAL C MEHTA BDS
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 3641 CONNALLY DR
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City | MARIANNA
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State | FL
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Zip | 32446-7972
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Country | US
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Telephone | 321-634-6392
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Fax |
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Provider Business Mailing Address
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Address Line | 3655 WEBB RD
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City | MARIANNA
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State | FL
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Zip | 32446-8047
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Country | US
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Telephone | 915-235-1178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 10953
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License Number State | FL
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