Mehta Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MEHTA DENTAL CORPORATION

Doing business as

WILDWOOD DENTAL GROUP

Practice address

3972 N Waterman Ave
Ste. 110
San Bernardino, CA 92404-1700

Phone

(951) 886-4864

Fax

(951) 882-0876

NPI assigned

Oct 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mahendra Kumar V. Mehta, DDS

Title

Owner DDS

Phone

(909) 886-4864

Specialties & licenses 1

Addresses

Other names 1

• WILDWOOD DENTAL GROUP Doing business as

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243987200000",
    "number": "1922192707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE",
            "address_2": "2ND FLOOR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926061009",
            "telephone_number": "714-508-3600",
            "fax_number": "714-368-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3972 N WATERMAN AVE",
            "address_2": "STE. 110",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924041700",
            "telephone_number": "951-886-4864",
            "fax_number": "951-882-0876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEHTA DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2009-06-03",
        "status": "A",
        "authorized_official_last_name": "MEHTA",
        "authorized_official_first_name": "MAHENDRA",
        "authorized_official_middle_name": "KUMAR V.",
        "authorized_official_title_or_position": "OWNER DDS",
        "authorized_official_telephone_number": "909-886-4864",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILDWOOD DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2009; 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.