Provider Demographics
NPI:1770609760
Name:MEHTA, SHUBHADA V (DDS)
Entity type:Individual
Prefix:DR
First Name:SHUBHADA
Middle Name:V
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 1:1128 W MISSION BLVD
Mailing Address - Street 2:UNIT D
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-4868
Mailing Address - Country:US
Mailing Address - Phone:909-984-9333
Mailing Address - Fax:909-984-9143
Practice Address - Street 1:1128 W MISSION BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-4868
Practice Address - Country:US
Practice Address - Phone:909-984-9333
Practice Address - Fax:909-984-9143
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist