Provider Demographics
NPI:1619360096
Name:SHARMA, RAJAN (MSD)
Entity Type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 FAIRVIEW AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2889
Mailing Address - Country:US
Mailing Address - Phone:630-960-4447
Mailing Address - Fax:
Practice Address - Street 1:6319 FAIRVIEW AVE STE 103
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2889
Practice Address - Country:US
Practice Address - Phone:630-960-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319.0110441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics