Healthcare Provider Details

I. General information

NPI: 1609051820
Provider Name (Legal Business Name): DR SURAJ PAL SHARMA D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8992 MISSION BLVD STE A
RIVERSIDE CA
92509-2874
US

IV. Provider business mailing address

8992 MISSION BLVD STE A
RIVERSIDE CA
92509-2874
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-5838
  • Fax: 951-352-5131
Mailing address:
  • Phone: 951-352-5838
  • Fax: 951-352-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD50531
License Number StateCA

VIII. Authorized Official

Name: ELAINE ANNE RICHARDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 951-352-5838