Healthcare Provider Details

I. General information

NPI: 1033020904
Provider Name (Legal Business Name): PRIYANK SETH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 SAGAMORE PKWY N STE 2
LAFAYETTE IN
47904-2800
US

IV. Provider business mailing address

2914 VININGS DR
CARMEL IN
46032-4085
US

V. Phone/Fax

Practice location:
  • Phone: 765-444-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12015147A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: