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General NPI Number Information
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NPI Number | 1942219480
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Entity Type | Individual
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Provider Name | SHWETA GAUTAM DAFTARY D.D.S
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 6009 BELT LINE RD STE 100
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City | DALLAS
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State | TX
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Zip | 75254-7890
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Country | US
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Telephone | 972-239-1998
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Fax | 972-239-8899
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Provider Business Mailing Address
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Address Line | 18020 CREEK VISTA CT
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City | DALLAS
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State | TX
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Zip | 75252-5622
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Country | US
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Telephone | 972-818-8600
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Fax | 214-853-4266
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17275
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License Number State | TX
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