Healthcare Provider Details

I. General information

NPI: 1780203356
Provider Name (Legal Business Name): DR. RAVISH SHARMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 INDEPENDENCE BLVD # 300
VIRGINIA BEACH VA
23462-6705
US

IV. Provider business mailing address

400 CROWN CT APT 562
EDGEWATER NJ
07020-1140
US

V. Phone/Fax

Practice location:
  • Phone: 757-224-3004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401419790
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: