Provider Demographics
NPI:1306645114
Name:DHARA MEHTA DENTAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DHARA MEHTA DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-952-9768
Mailing Address - Street 1:1572 SYCAMORE AVE STE G
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1772
Mailing Address - Country:US
Mailing Address - Phone:510-799-9345
Mailing Address - Fax:
Practice Address - Street 1:1572 SYCAMORE AVE STE G
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1772
Practice Address - Country:US
Practice Address - Phone:510-799-9345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental