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General NPI Number Information
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NPI Number | 1649768862
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Entity Type | Individual
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Provider Name | VIDIT HEMENDRAKUMAR MEHTA DDS
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Gender | Male
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 19071 BEAR VALLEY RD
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City | APPLE VALLEY
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State | CA
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Zip | 92308-2718
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Country | US
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Telephone | 760-810-4066
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Fax |
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Provider Business Mailing Address
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Address Line | 24929 PROSPECT AVE
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City | LOMA LINDA
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State | CA
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Zip | 92354-2811
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 102386
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License Number State | CA
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