Individual
SHREYA DIVYA LETTRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4504 W VICKERY BLVD, FORT WORTH, TX 76107-6224
(817) 332-0007
Mailing address
2741 MERRIMAC ST., #102, FORT WORTH, TX 76107
(832) 496-3645
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
203989
CO
1223P0221X
Pediatric Dentistry
Primary
37470
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/13/2017
Last updated
08/12/2021
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