Provider Demographics
NPI:1609051820
Name:DR SURAJ PAL SHARMA D.D.S.
Entity Type:Organization
Organization Name:DR SURAJ PAL SHARMA D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-352-5838
Mailing Address - Street 1:8992 MISSION BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-2874
Mailing Address - Country:US
Mailing Address - Phone:951-352-5838
Mailing Address - Fax:951-352-5131
Practice Address - Street 1:8992 MISSION BLVD STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-2874
Practice Address - Country:US
Practice Address - Phone:951-352-5838
Practice Address - Fax:951-352-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD505311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty