Basic Information
| Provider Information | |||||||||
| NPI: | 1841773785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHETH | ||||||||
| FirstName: | SONAM | ||||||||
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| Credential: | DMD, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 DOGWOOD DR | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068114530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037157006 | ||||||||
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| Practice Location | |||||||||
| Address1: | 376 COOLEY ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011281144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137961616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2018 | ||||||||
| LastUpdateDate: | 10/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 060107 | NY | N | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | 1223X0400X | 12393 | CT | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.