Provider Demographics
NPI:1366330631
Name:SHETTY, NARESH YEDTHARE (BDS, MDS, PHD)
Entity type:Individual
Prefix:DR
First Name:NARESH
Middle Name:YEDTHARE
Last Name:SHETTY
Suffix:
Gender:M
Credentials:BDS, MDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1309
Mailing Address - Country:US
Mailing Address - Phone:945-225-1128
Mailing Address - Fax:
Practice Address - Street 1:3000 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1309
Practice Address - Country:US
Practice Address - Phone:945-225-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX413701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery