Healthcare Provider Details

I. General information

NPI: 1053805440
Provider Name (Legal Business Name): SHIVANI KAMODIA BARTO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 CABLE ST
SAN DIEGO CA
92107-3103
US

IV. Provider business mailing address

4670 NEWPORT AVE
SAN DIEGO CA
92107-2944
US

V. Phone/Fax

Practice location:
  • Phone: 619-223-3423
  • Fax:
Mailing address:
  • Phone: 607-239-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number33944
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33944
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: