MEDICARE: PRAMILA B SHETH DDS

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	019021108	IL

General Provider Information

NPI Number	:	1902016009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAMILA B SHETH DDS

Provider Business Mailing Address
First Line	:	3705 E 106TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-6725
Country	:	US
Telephone Number	:	773-978-7773
Fax Number	:	773-978-0419

Provider Business Practice Location Address
First Line	:	3705 E 106TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-6725
Country	:	US
Telephone Number	:	773-978-7773
Fax Number	:	773-978-0419

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	01/21/2016

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