Provider Demographics
NPI:1407224132
Name:TEWARI, SHRUTI (DMD)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:TEWARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N 15TH ST
Mailing Address - Street 2:APT 803
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1516
Mailing Address - Country:US
Mailing Address - Phone:610-457-7182
Mailing Address - Fax:
Practice Address - Street 1:1804 RITTENHOUSE SQ
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5802
Practice Address - Country:US
Practice Address - Phone:215-735-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist