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General NPI Number Information
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NPI Number | 1457060782
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Entity Type | Organization
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Legal Business Name | SHARMA DENTAL GROUP
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 2616 PAVILION PKWY STE 104
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City | TRACY
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State | CA
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Zip | 95304-9408
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Country | US
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Telephone | 831-521-1356
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Fax |
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Provider Business Mailing Address
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Address Line | 2655 HENLEY PKWY UNIT 7312
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City | TRACY
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State | CA
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Zip | 95377-2235
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Country | US
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Telephone | 831-521-1356
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ASHU SHARMA
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Credential | DMD
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Telephone | 831-521-1356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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