Provider Demographics
NPI:1407465602
Name:SHARMA, VIDISHA (DMD)
Entity Type:Individual
Prefix:
First Name:VIDISHA
Middle Name:
Last Name:SHARMA
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 1:2326 YORK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2273
Mailing Address - Country:US
Mailing Address - Phone:410-828-5699
Mailing Address - Fax:
Practice Address - Street 1:2326 YORK RD STE 200
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2273
Practice Address - Country:US
Practice Address - Phone:410-828-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD175861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry