Provider Demographics
NPI:1073831426
Name:SHETH, RAJAN KANTI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:KANTI
Last Name:SHETH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5259 GREENSEDGE WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2557
Mailing Address - Country:US
Mailing Address - Phone:513-546-5492
Mailing Address - Fax:
Practice Address - Street 1:5259 GREENSEDGE WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2557
Practice Address - Country:US
Practice Address - Phone:513-546-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIN PROGRESS1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054443Medicaid