Provider Demographics
NPI:1558148965
Name:SHARMA, KULDEEP (DDS)
Entity Type:Individual
Prefix:
First Name:KULDEEP
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 COWELL BLVD APT 610
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6017
Mailing Address - Country:US
Mailing Address - Phone:770-344-8173
Mailing Address - Fax:
Practice Address - Street 1:1370 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3426
Practice Address - Country:US
Practice Address - Phone:844-296-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist