Provider Demographics
NPI:1295475408
Name:SHETH, ATMIYA
Entity type:Individual
Prefix:
First Name:ATMIYA
Middle Name:
Last Name:SHETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4745
Mailing Address - Country:US
Mailing Address - Phone:708-402-9135
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-9800
Practice Address - Country:US
Practice Address - Phone:206-543-7496
Practice Address - Fax:206-685-7222
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034647122300000X
390200000X
WADR61426866204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery