Provider Demographics
NPI:1497197750
Name:SHARMA, SAKSHI (DDS BDS)
Entity Type:Individual
Prefix:
First Name:SAKSHI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:DDS BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601B W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2119
Mailing Address - Country:US
Mailing Address - Phone:315-781-8448
Mailing Address - Fax:315-781-8444
Practice Address - Street 1:3905 N WHEELING AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304
Practice Address - Country:US
Practice Address - Phone:765-286-4017
Practice Address - Fax:765-286-0372
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012868A1223P0221X
NY0575201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300012362Medicaid
NY057520OtherLICENSE