Healthcare Provider Details

I. General information

NPI: 1073820189
Provider Name (Legal Business Name): KOMAL SHARMA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 05/13/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11775 N I-35 SUITE 110
JARRELL TX
76537-4705
US

IV. Provider business mailing address

11775 N I-35 SUITE 110
JARRELL TX
76537
US

V. Phone/Fax

Practice location:
  • Phone: 305-297-5618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS038477
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32438
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: