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General NPI Number Information
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NPI Number | 1538905120
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Entity Type | Individual
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Provider Name | SHWETA DEY
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Gender | Female
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Dates
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Enumeration Date | 07/03/2024
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 1401 N VETERANS PKWY
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City | BLOOMINGTON
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State | IL
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Zip | 61704-2296
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Country | US
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Telephone | 309-319-9577
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 RUDDER LN APT 112
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City | BLOOMINGTON
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State | IL
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Zip | 61704-8780
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Country | US
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Telephone | 323-961-2735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.035444
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License Number State | IL
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