Healthcare Provider Details

I. General information

NPI: 1750793147
Provider Name (Legal Business Name): SHERNA SHETH DDS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 TIJERAS AVE NE STE 22
ALBUQUERQUE NM
87106-4749
US

IV. Provider business mailing address

MSC 10-5610 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-1670
  • Fax:
Mailing address:
  • Phone: 505-272-6451
  • Fax: 505-925-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414163
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD2024-1148
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: