Provider Demographics
NPI:1053471441
Name:MEHTA, AMI RAMESH (DDS)
Entity type:Individual
Prefix:DR
First Name:AMI
Middle Name:RAMESH
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1401 E SANTO ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4201
Mailing Address - Country:US
Mailing Address - Phone:909-653-3166
Mailing Address - Fax:909-825-7836
Practice Address - Street 1:15290 BEAR VALLEY RD STE B
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8515
Practice Address - Country:US
Practice Address - Phone:760-951-7777
Practice Address - Fax:760-951-1582
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA54441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist