Healthcare Provider Details

I. General information

NPI: 1811650138
Provider Name (Legal Business Name): DR. ANKITA SHARMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 MICHIGAN AVE
BALDWIN MI
49304-7984
US

IV. Provider business mailing address

1615 MICHIGAN AVE
BALDWIN MI
49304-7984
US

V. Phone/Fax

Practice location:
  • Phone: 231-745-2736
  • Fax: 231-745-0412
Mailing address:
  • Phone: 231-745-2736
  • Fax: 231-745-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601161
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: