Provider Demographics
NPI:1164632261
Name:SHETH, BHARAT N (DDS)
Entity Type:Individual
Prefix:
First Name:BHARAT
Middle Name:N
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 1:11921 BRAMLETTE CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7325
Mailing Address - Country:US
Mailing Address - Phone:708-349-8818
Mailing Address - Fax:
Practice Address - Street 1:1858 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1201
Practice Address - Country:US
Practice Address - Phone:773-247-5554
Practice Address - Fax:773-247-8272
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice