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General NPI Number Information
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NPI Number | 1750893236
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Entity Type | Individual
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Provider Name | ANJALI SUDERSHAN KRISHAN MEHTA DMD
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Gender | Female
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 8001 W NATIONAL AVE
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City | WEST ALLIS
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State | WI
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Zip | 53214-4507
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Country | US
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Telephone | 414-327-6363
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Fax |
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Provider Business Mailing Address
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Address Line | N55W21136 LOGAN DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-6277
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Country | US
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Telephone | 414-731-7848
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1001708-15
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License Number State | WI
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