Thankachen, Pavithra Shetty

Thankachen, Pavithra Shetty is an individual health care provider with primary practice located at 2131 East Coast Hwy Suite 220 , Corona Del Mar CA 92625-3421. She recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is her primary health care specialty. Thankachen, Pavithra Shetty can be contacted via phone (949) 644-1001.

Contact Information

Primary practice address
2131 East Coast Hwy Suite 220 Corona Del Mar CA 92625-3421
Phone: (949) 644-1001
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 51522 California
Dental Providers / General Practice 1223G0001X 0518561 New York
Dental Providers / General Practice 1223G0001X 51522 California

Profile Details

NPI number 1720196173
LBN Legal business name Thankachen, Pavithra Shetty
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 27th, 2006
Last updated Mar 3rd, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720196173 NPPES
California MEDICAID 51522

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