MEDICARE: SHARON LINDO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS035800	PA
2	122300000X	Dentist	0401413330	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124031315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON LINDO DMD

Provider Business Mailing Address
First Line	:	1090 NORTHCHASE PKWY SE, SUITE 290
Second Line	:	KOOL SMILES SUPPORT SERVICES OFFICE/NDRC,LLC
City	:	MARIETTA
State	:	GA
Zip	:	30067
Country	:	US
Telephone Number	:	678-904-5665
Fax Number	:	678-247-7862

Provider Business Practice Location Address
First Line	:	5900 E VIRGINIA BEACH BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2473
Country	:	US
Telephone Number	:	757-644-4356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/18/2011

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