Provider Demographics
NPI:1861946709
Name:SHRESTHA, SWAPNIMA (DMD)
Entity type:Individual
Prefix:
First Name:SWAPNIMA
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:717-248-9900
Mailing Address - Fax:717-248-9910
Practice Address - Street 1:106 DERRY HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-8604
Practice Address - Country:US
Practice Address - Phone:717-248-9900
Practice Address - Fax:717-248-9910
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031183840002Medicaid
PA1031183840004Medicaid
PA1031183840005Medicaid
PA1031183840003Medicaid
PA1031183840006Medicaid
PA1031183840007Medicaid