Provider Demographics
NPI:1942314687
Name:SHETTY, DEEPAK HIRIANNA (DDS)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:HIRIANNA
Last Name:SHETTY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 CAHALAN AVE
Mailing Address - Street 2:BLDG.3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3010
Mailing Address - Country:US
Mailing Address - Phone:408-225-6815
Mailing Address - Fax:408-578-8309
Practice Address - Street 1:5710 CAHALAN AVE
Practice Address - Street 2:BLDG.3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3010
Practice Address - Country:US
Practice Address - Phone:408-225-6815
Practice Address - Fax:408-578-8309
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD48378OtherDENTICAL