MEDICARE: DR. SHEFFALI SHETH-NADLER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30-02-0450	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649264508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEFFALI SHETH-NADLER DMD

Provider Business Mailing Address
First Line	:	4817 MAHONING AVE NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-1430
Country	:	US
Telephone Number	:	330-847-0676
Fax Number	:

Provider Business Practice Location Address
First Line	:	4817 MAHONING AVE NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-1430
Country	:	US
Telephone Number	:	330-847-0676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	03/11/2008

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