Healthcare Provider Details

I. General information

NPI: 1457060782
Provider Name (Legal Business Name): SHARMA DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 PAVILION PKWY STE 104
TRACY CA
95304-9408
US

IV. Provider business mailing address

2655 HENLEY PKWY UNIT 7312
TRACY CA
95377-2235
US

V. Phone/Fax

Practice location:
  • Phone: 831-521-1356
  • Fax:
Mailing address:
  • Phone: 831-521-1356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHU SHARMA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DMD
Phone: 831-521-1356