Provider Demographics
NPI:1538643358
Name:SETHI, AMIT (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:SETHI
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 1:58 BAY STATE RD APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1910
Mailing Address - Country:US
Mailing Address - Phone:617-721-4993
Mailing Address - Fax:
Practice Address - Street 1:100 E NEWTON ST # G407
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-358-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADF114001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADF11400OtherBOARD OF REGISTRATION IN DENTISTRY, COMMONWEALTH OF MASSACHUSETTS