Provider Demographics
NPI:1053805440
Name:BARTO, SHIVANI KAMODIA (DDS)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:KAMODIA
Last Name:BARTO
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 1:11815 VANCE JACKSON RD APT 904
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1456
Mailing Address - Country:US
Mailing Address - Phone:607-239-0910
Mailing Address - Fax:
Practice Address - Street 1:6212 DE ZAVALA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2201
Practice Address - Country:US
Practice Address - Phone:607-239-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty