Provider Demographics
NPI:1598929663
Name:PRIVEER D SHARMA DDS PA
Entity Type:Organization
Organization Name:PRIVEER D SHARMA DDS PA
Other - Org Name:ORAL FACIAL & IMPLANT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIVEER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-541-6070
Mailing Address - Street 1:11220 ELM LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0715
Mailing Address - Country:US
Mailing Address - Phone:704-541-6070
Mailing Address - Fax:
Practice Address - Street 1:11220 ELM LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0715
Practice Address - Country:US
Practice Address - Phone:704-541-6070
Practice Address - Fax:704-541-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty