Provider Demographics
NPI:1053676783
Name:SHETH, VIDHI
Entity Type:Individual
Prefix:DR
First Name:VIDHI
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SE TUALATIN VALLEY HWY
Mailing Address - Street 2:STE A16
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5097
Mailing Address - Country:US
Mailing Address - Phone:503-693-1217
Mailing Address - Fax:503-693-1137
Practice Address - Street 1:1001 SE TUALATIN VALLEY HWY
Practice Address - Street 2:STE A16
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-5097
Practice Address - Country:US
Practice Address - Phone:503-693-1217
Practice Address - Fax:503-693-1137
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD97311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice