=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144828765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARMA ORTHODONTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2020
-----------------------------------------------------
Last Update Date | 10/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3535 ROSWELL RD STE 53
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30062-8828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-433-1317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 WESLEY OAKS CT NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30327-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-433-1317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JYOTI DESH SHARMA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 404-433-1317
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------