Provider Demographics
NPI:1568733616
Name:SETHI, AMIT (BDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:SETHI
Suffix:
Gender:M
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 ADLER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211
Mailing Address - Country:US
Mailing Address - Phone:214-331-7275
Mailing Address - Fax:214-331-7267
Practice Address - Street 1:4475 ADLER DR STE 103
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211
Practice Address - Country:US
Practice Address - Phone:214-331-7275
Practice Address - Fax:214-331-7267
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27639122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131637480Medicaid