Provider Demographics
NPI:1235370966
Name:SHETTY, ARAVINDA KUMAR
Entity Type:Individual
Prefix:DR
First Name:ARAVINDA
Middle Name:KUMAR
Last Name:SHETTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 137
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2826
Mailing Address - Country:US
Mailing Address - Phone:949-682-5110
Mailing Address - Fax:
Practice Address - Street 1:657 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 137
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2826
Practice Address - Country:US
Practice Address - Phone:949-682-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB29463-02OtherDENTI-CAL