Provider Demographics
NPI:1841773785
Name:SHETH, SONAM (DMD, MS)
Entity Type:Individual
Prefix:
First Name:SONAM
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4530
Mailing Address - Country:US
Mailing Address - Phone:203-715-7006
Mailing Address - Fax:
Practice Address - Street 1:376 COOLEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01128-1144
Practice Address - Country:US
Practice Address - Phone:413-796-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0601071223X0400X
CT123931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics