Provider Demographics
NPI:1083797740
Name:SHARMA, SHYAM S (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHYAM
Middle Name:S
Last Name:SHARMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18660 BAGLEY RD STE 405B
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8492
Mailing Address - Country:US
Mailing Address - Phone:440-297-4365
Mailing Address - Fax:440-298-4054
Practice Address - Street 1:18660 BAGLEY RD STE 405B
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8492
Practice Address - Country:US
Practice Address - Phone:440-297-4365
Practice Address - Fax:440-297-4054
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341958892026OtherCARESOURCE
OH0208966Medicaid