=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316374580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMIT SETHI BDS, MDS, CERT ENDO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2013
-----------------------------------------------------
Last Update Date | 03/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4475 ADLER DR STE 103
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-331-7275
-----------------------------------------------------
Fax | 214-331-7267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4475 ADLER DR STE 103
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-331-7275
-----------------------------------------------------
Fax | 214-331-7267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. AMIT SETHI
-----------------------------------------------------
Credential | BDS, MDS
-----------------------------------------------------
Telephone | 214-331-7275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 27639
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------