MEDICARE: DR. KARISHMA SHETH D.D.S

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	1223G0001X	General Practice Dentistry	23319	TX
2	1223G0001X	General Practice Dentistry	054662	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23319	OTHER	TX	LICENSE
2	054662	OTHER	NY	NYS

General Provider Information

NPI Number	:	1326217878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARISHMA SHETH D.D.S

Provider Business Mailing Address
First Line	:	201 50TH AVE
Second Line	:	APT P4C
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5739
Country	:	US
Telephone Number	:	415-336-7178
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 50TH AVE
Second Line	:	APT P4C
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5739
Country	:	US
Telephone Number	:	415-336-7178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	09/08/2009

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