Provider Demographics
NPI:1235109034
Name:SHARMA, ROOPALI (BDS)
Entity Type:Individual
Prefix:
First Name:ROOPALI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:ESKO
Mailing Address - State:MN
Mailing Address - Zip Code:55733-9701
Mailing Address - Country:US
Mailing Address - Phone:218-879-8355
Mailing Address - Fax:
Practice Address - Street 1:4 W HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:ESKO
Practice Address - State:MN
Practice Address - Zip Code:55733-9701
Practice Address - Country:US
Practice Address - Phone:218-879-8355
Practice Address - Fax:218-879-8352
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND119911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN418192100Medicaid