1942211073 NPI number — MRS. DIPA NIRAV MEHTA DDS

Table of content: MRS. DIPA NIRAV MEHTA DDS (NPI 1942211073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942211073 NPI number — MRS. DIPA NIRAV MEHTA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
DIPA
Provider Middle Name:
NIRAV
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUTALA
Provider Other First Name:
DIPA
Provider Other Middle Name:
PRADYUMNA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942211073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
895 E FREMONT AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-732-0220
Provider Business Mailing Address Fax Number:
408-469-4993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
895 E FREMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-732-0220
Provider Business Practice Location Address Fax Number:
408-469-4993
Provider Enumeration Date:
08/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  49478 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)