Provider Demographics
NPI:1568600039
Name:AMISH SHETH DMD LLC
Entity Type:Organization
Organization Name:AMISH SHETH DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-242-8607
Mailing Address - Street 1:3125 W BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1546
Mailing Address - Country:US
Mailing Address - Phone:267-242-8607
Mailing Address - Fax:
Practice Address - Street 1:1126 GENERAL WASHINGTON MEM BLVD
Practice Address - Street 2:
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1304
Practice Address - Country:US
Practice Address - Phone:215-493-4047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0360631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty