MEDICARE: MRS. SHWETA GAUTAM DAFTARY 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	17275	TX

General Provider Information

NPI Number	:	1942219480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHWETA GAUTAM DAFTARY D.D.S

Provider Business Mailing Address
First Line	:	18020 CREEK VISTA CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5622
Country	:	US
Telephone Number	:	972-818-8600
Fax Number	:	214-853-4266

Provider Business Practice Location Address
First Line	:	6009 BELT LINE RD STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-7890
Country	:	US
Telephone Number	:	972-239-1998
Fax Number	:	972-239-8899

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	02/01/2022

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