MEDICARE: ENDODONTIC SPECIALISTS OF FRISCO, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1235726373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDODONTIC SPECIALISTS OF FRISCO, PLLC

Provider Business Mailing Address
First Line	:	255 W LEBANON STE 308
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-3415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 W LEBANON STE 308
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-3415
Country	:	US
Telephone Number	:	469-830-1425
Fax Number	:	469-830-1427

Authorized Official
Title or Position	:	ENDODONTIST
Name	:	DR. SHAVETA SETHI
Credential	:	DDS
Telephone Number	:	469-830-1425

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	12/23/2020

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