=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558494310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHOK MEHTA, DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10900 LOS ALAMITOS BLVD STE 133
-----------------------------------------------------
City | LOS ALAMITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90720-5612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-596-8888
-----------------------------------------------------
Fax | 562-596-8178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10900 LOS ALAMITOS BLVD STE 133
-----------------------------------------------------
City | LOS ALAMITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90720-5612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-596-8888
-----------------------------------------------------
Fax | 562-596-8178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ASHOK MEHTA II
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 714-928-4299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 28761
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------