Provider Demographics
NPI:1174944151
Name:DENTAL ASSOCIATES OF LAKE MARY, P.A
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF LAKE MARY, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-829-2123
Mailing Address - Street 1:1301 S INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 2041
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2041
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1409
Practice Address - Country:US
Practice Address - Phone:407-829-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17281261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental