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General NPI Number Information
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NPI Number | 1508934951
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Entity Type | Individual
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Provider Name | DHAVAL TUSHAR MEHTA D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17 S. 60TH ST. 2ND FLR.
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City | PHILADELPHIA
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State | PA
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Zip | 19139
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Country | US
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Telephone | 215-472-4500
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Fax | 215-472-4009
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Provider Business Mailing Address
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Address Line | 121 FARM VIEW DR
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City | OXFORD
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State | PA
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Zip | 19363-2445
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Country | US
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Telephone | 610-998-9540
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Fax | 215-472-4009
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS029462L
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License Number State | PA
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