MEDICARE: DR. SHOBA VISWANATHAN 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	122300000X	Dentist	12012403A	IN

General Provider Information

NPI Number	:	1780833020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHOBA VISWANATHAN D.D.S

Provider Business Mailing Address
First Line	:	894 SIM HODGIN PKWY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1931
Country	:	US
Telephone Number	:	415-335-3537
Fax Number	:

Provider Business Practice Location Address
First Line	:	894 SIM HODGIN PKWY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1931
Country	:	US
Telephone Number	:	415-335-3537
Fax Number	:

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

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	03/24/2022

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Directions to “ DR. SHOBA VISWANATHAN D.D.S” Practice Location

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