Provider Demographics
NPI:1598001166
Name:ASHMITA SHETTY, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ASHMITA SHETTY, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-348-5973
Mailing Address - Street 1:2664 BERRYESSA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2925
Mailing Address - Country:US
Mailing Address - Phone:408-254-1760
Mailing Address - Fax:408-416-3288
Practice Address - Street 1:2664 BERRYESSA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2925
Practice Address - Country:US
Practice Address - Phone:408-254-1760
Practice Address - Fax:408-416-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty