Provider Demographics
NPI:1679931893
Name:SHETTY, DEEPTHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEEPTHI
Middle Name:
Last Name:SHETTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 PRESTON RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8612
Mailing Address - Country:US
Mailing Address - Phone:972-612-0553
Mailing Address - Fax:
Practice Address - Street 1:3516 PRESTON RD
Practice Address - Street 2:SUITE 600
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8612
Practice Address - Country:US
Practice Address - Phone:972-612-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31192122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist