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General NPI Number Information
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NPI Number | 1497343131
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Entity Type | Individual
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Provider Name | SIDDARTH MEHTA DMD
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Gender | Male
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 03/10/2024
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Provider Practice Location Address
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Address Line | 3 SW 129TH AVE STE 205
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1779
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Country | US
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Telephone | 561-740-3646
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Fax |
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Provider Business Mailing Address
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Address Line | 405 NE 2ND ST APT 2111
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-2865
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Country | US
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Telephone | 574-386-1989
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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 | DN25437
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License Number State | FL
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