Individual provider Active NPI

Aditi Mehndiratta

  • General Practice Dentistry
  • Sacramento, CA
National Provider Identifier
1104425248
Registry record updated Jul 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
105453 Issued in CA
Practice address
3640 Crocker Ave Ste 130
Sacramento, CA 95818-3970
Phone
(916) 550-9429
NPI assigned
Oct 20, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 105453 CA Primary

Addresses

Primary practice location

3640 Crocker Ave Ste 130
Sacramento, CA 95818-3970

Mailing address

1714 21St St Apt 117
Sacramento, CA 95811-6860
Phone (628) 240-9186

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
105453CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Reymond Bautista Dental Corporation General Practice PastSince Jul 17, 2021 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: aditi.mehndiratta.p1@direct.omnifamilyhealth.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625270400000",
    "number": "1104425248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 21ST ST APT 117",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958116860",
            "telephone_number": "628-240-9186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 CROCKER AVE STE 130",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958183970",
            "telephone_number": "916-550-9429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHNDIRATTA",
        "first_name": "ADITI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-20",
        "last_updated": "2021-07-03",
        "certification_date": "2021-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.