Healthcare Provider Details

I. General information

NPI: 1205152766
Provider Name (Legal Business Name): SHARMA-BHUI EXCEL DENTAL, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 NW 1ST ST SUITE 120
BATTLE GROUND WA
98604-4540
US

IV. Provider business mailing address

1401 NW 1ST ST SUITE 120
BATTLE GROUND WA
98604-4540
US

V. Phone/Fax

Practice location:
  • Phone: 360-666-5700
  • Fax: 360-666-5701
Mailing address:
  • Phone: 360-666-5700
  • Fax: 360-666-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8609
License Number StateWA

VIII. Authorized Official

Name: ANDREA YOUNG
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-666-5700