Provider Demographics
NPI:1194816827
Name:SURAJ PAL SHARMA, DDS INC
Entity Type:Organization
Organization Name:SURAJ PAL SHARMA, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SURAJ
Authorized Official - Middle Name:PAL
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-352-5838
Mailing Address - Street 1:5515 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-2066
Mailing Address - Country:US
Mailing Address - Phone:951-352-5838
Mailing Address - Fax:951-352-5131
Practice Address - Street 1:5515 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2066
Practice Address - Country:US
Practice Address - Phone:951-352-5838
Practice Address - Fax:951-352-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty