MEDICARE: DR. PRIYANKA KEITH MEHTA D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.029611	IL

General Provider Information

NPI Number	:	1467893495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYANKA KEITH MEHTA D.D.S

Provider Business Mailing Address
First Line	:	2167 WILDWOOD CT
Second Line	:
City	:	HANOVER PARK
State	:	IL
Zip	:	60133-6770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 N ROOT ST
Second Line	:	SUITE #105
City	:	AURORA
State	:	IL
Zip	:	60505-3429
Country	:	US
Telephone Number	:	630-800-1137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2013
Last Update Date	:	05/14/2014

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Directions to “ DR. PRIYANKA KEITH MEHTA D.D.S” Practice Location

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