Provider Demographics
NPI:1215101803
Name:MEHTA, KHUYEN VU (DMD)
Entity type:Individual
Prefix:DR
First Name:KHUYEN
Middle Name:VU
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14815 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2027
Mailing Address - Country:US
Mailing Address - Phone:813-264-1993
Mailing Address - Fax:813-289-4500
Practice Address - Street 1:14815 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2027
Practice Address - Country:US
Practice Address - Phone:813-264-1993
Practice Address - Fax:813-289-4500
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist