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General NPI Number Information
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NPI Number | 1952049074
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Entity Type | Organization
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Legal Business Name | DENTISTRY OF THE PONDS P.L.L.C.
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 436 POND PROMENADE
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City | CHANHASSEN
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State | MN
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Zip | 55317-8307
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Country | US
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Telephone | 952-906-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 12511 PORTLAND AVE APT 118
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City | BURNSVILLE
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State | MN
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Zip | 55337-7508
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Country | US
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Telephone | 865-360-4413
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MONIL MEHTA
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Credential | DMD
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Telephone | 865-360-4413
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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 |
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License Number State |
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