MEDICARE: DR. JITEN SHETH BDS,MS

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	DN11877	FL

General Provider Information

NPI Number	:	1821187139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JITEN SHETH BDS,MS

Provider Business Mailing Address
First Line	:	320 LEXINGTON GREEN LN
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-1023
Country	:	US
Telephone Number	:	407-878-5888
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 LEXINGTON GREEN LN
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-1023
Country	:	US
Telephone Number	:	407-878-5888
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	06/28/2010

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