MEDICARE: KAAJAL MEHRA

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	1223G0001X	General Practice Dentistry	24715	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24715	OTHER	TX	TEXAS DENTAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952533689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAAJAL MEHRA

Provider Business Mailing Address
First Line	:	PO BOX 1168
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36202-1168
Country	:	US
Telephone Number	:	256-741-7340
Fax Number	:

Provider Business Practice Location Address
First Line	:	4323 LEMMON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2706
Country	:	US
Telephone Number	:	214-522-4444
Fax Number	:

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

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	03/17/2018

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