Provider Demographics
NPI:1699966515
Name:ZALA, MITESH BHARATSINH (DDS)
Entity type:Individual
Prefix:
First Name:MITESH
Middle Name:BHARATSINH
Last Name:ZALA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18403 KAMSTRA AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6113
Mailing Address - Country:US
Mailing Address - Phone:415-505-8108
Mailing Address - Fax:
Practice Address - Street 1:18403 KAMSTRA AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6113
Practice Address - Country:US
Practice Address - Phone:415-505-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice