Provider Demographics
NPI:1053955492
Name:SHETH DENTAL CORPORATION
Entity type:Organization
Organization Name:SHETH DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-530-4300
Mailing Address - Street 1:14522 LEIBACHER AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4648
Mailing Address - Country:US
Mailing Address - Phone:562-477-5170
Mailing Address - Fax:310-530-4314
Practice Address - Street 1:2945 ROLLING HILLS RD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7146
Practice Address - Country:US
Practice Address - Phone:310-530-4300
Practice Address - Fax:310-530-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty