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General NPI Number Information
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NPI Number | 1730719253
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Entity Type | Organization
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Legal Business Name | LAWRENCEVILLE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 4850 SUGARLOAF PKWY STE 611
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2866
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Country | US
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Telephone | 678-629-3663
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 SUGARLOAF PKWY STE 611
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2866
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Country | US
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Telephone | 678-629-3663
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | SHIKHA SHARMA
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Credential | DDS, MS
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Telephone | 404-786-7616
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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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