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General NPI Number Information
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NPI Number | 1487683702
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Entity Type | Individual
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Provider Name | CHETAN KUMAR MEHTA D.M.D., M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13372 NEWPORT AVE SUITE C
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City | TUSTIN
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State | CA
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Zip | 92780-3426
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Country | US
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Telephone | 714-838-1238
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Fax | 714-838-9586
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Provider Business Mailing Address
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Address Line | 5 VILLAGER
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City | IRVINE
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State | CA
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Zip | 92602-2459
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Country | US
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Telephone | 714-389-1919
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D49597
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License Number State | CA
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