Provider Demographics
NPI:1104425248
Name:MEHNDIRATTA, ADITI
Entity type:Individual
Prefix:
First Name:ADITI
Middle Name:
Last Name:MEHNDIRATTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 21ST ST APT 117
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-6860
Mailing Address - Country:US
Mailing Address - Phone:628-240-9186
Mailing Address - Fax:
Practice Address - Street 1:3640 CROCKER AVE STE 130
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-3970
Practice Address - Country:US
Practice Address - Phone:916-550-9429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1054531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice