Provider Demographics
NPI:1760978647
Name:SHETH, DIKSHA K
Entity Type:Individual
Prefix:
First Name:DIKSHA
Middle Name:K
Last Name:SHETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5373 LAS COLINAS BLVD APT 1612
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4490
Mailing Address - Country:US
Mailing Address - Phone:651-332-0595
Mailing Address - Fax:
Practice Address - Street 1:5017 TEASLEY LN STE 165
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-3895
Practice Address - Country:US
Practice Address - Phone:940-387-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14075122300000X
TX380341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist