Provider Demographics
NPI:1477656478
Name:SHETH, PURNIMA JITEN (BDS)
Entity Type:Individual
Prefix:MRS
First Name:PURNIMA
Middle Name:JITEN
Last Name:SHETH
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 W OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809
Mailing Address - Country:US
Mailing Address - Phone:407-363-1777
Mailing Address - Fax:407-363-1777
Practice Address - Street 1:4029 W OAKRIDGE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809
Practice Address - Country:US
Practice Address - Phone:407-363-1777
Practice Address - Fax:407-363-1777
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN129661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070406700Medicaid