Healthcare Provider Details

I. General information

NPI: 1194893917
Provider Name (Legal Business Name): SANGEETA SETHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 E 163 ST
BRONX NY
10459
US

IV. Provider business mailing address

1022 E 163 ST
BRONX NY
10459
US

V. Phone/Fax

Practice location:
  • Phone: 718-542-2088
  • Fax: 718-542-2053
Mailing address:
  • Phone: 718-542-2088
  • Fax: 718-542-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number08858
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15773
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0440511
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number08858
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15773
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0440511
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0440511
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: