Provider Demographics
NPI:1376681668
Name:DESOUZA, SHARON M (DMD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:DESOUZA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 MILLWICK DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4536 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:SUITE 211
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6200
Practice Address - Country:US
Practice Address - Phone:770-455-1238
Practice Address - Fax:770-455-4576
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0124441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry