Provider Demographics
NPI:1942219480
Name:DAFTARY, SHWETA GAUTAM (DDS)
Entity Type:Individual
Prefix:MRS
First Name:SHWETA
Middle Name:GAUTAM
Last Name:DAFTARY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18020 CREEK VISTA CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5622
Mailing Address - Country:US
Mailing Address - Phone:972-818-8600
Mailing Address - Fax:214-853-4266
Practice Address - Street 1:6009 BELT LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7890
Practice Address - Country:US
Practice Address - Phone:972-239-1998
Practice Address - Fax:972-239-8899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX172751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice