MEDICARE: SHARMA ORTHODONTICS LLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1215231667	OTHER	GA	NPEES
2	1891873758	OTHER	GA	NPEES

General Provider Information

NPI Number	:	1144828765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARMA ORTHODONTICS LLC

Provider Business Mailing Address
First Line	:	1400 WESLEY OAKS CT NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-1864
Country	:	US
Telephone Number	:	404-433-1317
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 ROSWELL RD STE 53
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-8828
Country	:	US
Telephone Number	:	404-433-1317
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JYOTI DESH SHARMA
Credential	:	DMD
Telephone Number	:	404-433-1317

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	10/15/2020

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Directions to “SHARMA ORTHODONTICS LLC ” Practice Location

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