Provider Demographics
NPI:1619194982
Name:SHETH, SHAMKANT P (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAMKANT
Middle Name:P
Last Name:SHETH
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 1:32 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7738
Mailing Address - Country:US
Mailing Address - Phone:630-240-3306
Mailing Address - Fax:
Practice Address - Street 1:7702 S CASS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5093
Practice Address - Country:US
Practice Address - Phone:630-810-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist