Basic Information
Provider Information
NPI: 1821285495
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SETHI
FirstName: MUDITA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11489 CERRILLOS DR
Address2:  
City: FRISCO
State: TX
PostalCode: 750355082
CountryCode: US
TelephoneNumber: 8482480742
FaxNumber:  
Practice Location
Address1: 3610 W UNIVERSITY DR STE 400
Address2:  
City: MCKINNEY
State: TX
PostalCode: 75071
CountryCode: US
TelephoneNumber: 9725489956
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/27/2007
LastUpdateDate: 04/08/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X25887TXY Dental ProvidersDentistGeneral Practice

No ID Information.


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