Provider Demographics
NPI:1053972745
Name:DESHMUKH, SHWETA (DMD)
Entity type:Individual
Prefix:
First Name:SHWETA
Middle Name:
Last Name:DESHMUKH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SUMMIT AVE APT B218
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2345
Mailing Address - Country:US
Mailing Address - Phone:346-247-1338
Mailing Address - Fax:
Practice Address - Street 1:4403 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5616
Practice Address - Country:US
Practice Address - Phone:855-289-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice