MEDICARE: RAJAN SHARMA, DDS, MSD, PC

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	1223E0200X	Endodontics	021-001569	IL

General Provider Information

NPI Number	:	1225264179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAJAN SHARMA, DDS, MSD, PC

Provider Business Mailing Address
First Line	:	1424 E 53RD ST
Second Line	:	#209
City	:	CHICAGO
State	:	IL
Zip	:	60615-4500
Country	:	US
Telephone Number	:	773-667-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1424 E 53RD ST
Second Line	:	#209
City	:	CHICAGO
State	:	IL
Zip	:	60615-4500
Country	:	US
Telephone Number	:	773-667-3636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAJAN SHARMA
Credential	:
Telephone Number	:	773-667-3636

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	06/05/2009

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