Healthcare Provider Details

I. General information

NPI: 1497984157
Provider Name (Legal Business Name): SACHIN VERMA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 WASHINGTON RD
KENOSHA WI
53144-4819
US

IV. Provider business mailing address

4006 WASHINGTON RD
KENOSHA WI
53144-4819
US

V. Phone/Fax

Practice location:
  • Phone: 262-656-0044
  • Fax:
Mailing address:
  • Phone: 262-656-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019028017
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6604-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: