Provider Demographics
NPI:1992226328
Name:YASH MEHTA DMD PC
Entity type:Organization
Organization Name:YASH MEHTA DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:240-678-9342
Mailing Address - Street 1:8150 WASHINGTON BLVD #113 SUITE H 1
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-8808
Mailing Address - Country:US
Mailing Address - Phone:240-678-9342
Mailing Address - Fax:
Practice Address - Street 1:8150 WASHINGTON BLVD #113 SUITE H 1
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-8808
Practice Address - Country:US
Practice Address - Phone:240-678-9342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14634261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental