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General NPI Number Information
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NPI Number | 1952661258
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Entity Type | Organization
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Legal Business Name | MEENA H. MEHTA
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 3981 LAWRENCEVILLE HWY STE A
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City | TUCKER
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State | GA
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Zip | 30084-4525
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Country | US
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Telephone | 770-491-1138
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Fax | 770-491-1168
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Provider Business Mailing Address
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Address Line | 3981 LAWRENCEVILLE HWY STE A
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City | TUCKER
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State | GA
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Zip | 30084-4525
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Country | US
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Telephone | 770-491-1138
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Fax | 770-491-1168
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. MEENA H MEHTA
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Credential | DDS
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Telephone | 770-491-1138
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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 | 10499
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License Number State | GA
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