Provider Demographics
NPI:1316994510
Name:MEHTA, NOMITA (DDS)
Entity type:Individual
Prefix:
First Name:NOMITA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 WEST NOB HILL BLVD #A
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4982
Mailing Address - Country:US
Mailing Address - Phone:509-576-0600
Mailing Address - Fax:509-576-0602
Practice Address - Street 1:2802 W NOB HILL BLVD # A
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4982
Practice Address - Country:US
Practice Address - Phone:509-576-0600
Practice Address - Fax:509-576-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE8769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE8769OtherSTATE PROFESIONAL LICENSE
WA5038658Medicaid