Provider Demographics
NPI:1902016009
Name:SHETH, PRAMILA B (DDS)
Entity Type:Individual
Prefix:
First Name:PRAMILA
Middle Name:B
Last Name:SHETH
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 1:3705 E 106TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-6725
Mailing Address - Country:US
Mailing Address - Phone:773-978-7773
Mailing Address - Fax:773-978-0419
Practice Address - Street 1:3705 E 106TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-6725
Practice Address - Country:US
Practice Address - Phone:773-978-7773
Practice Address - Fax:773-978-0419
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190211081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice