Provider Demographics
NPI:1235205568
Name:SHARMA, SWATI LAVANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SWATI
Middle Name:LAVANI
Last Name:SHARMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2757 N BROOKBURY XING
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4386
Mailing Address - Country:US
Mailing Address - Phone:479-582-3337
Mailing Address - Fax:
Practice Address - Street 1:2901 E ZION RD
Practice Address - Street 2:SUITE 12
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5007
Practice Address - Country:US
Practice Address - Phone:479-251-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148479608Medicaid