Provider Demographics
NPI:1629057559
Name:LUDU SHARMA PROFESSIONAL SERVICES PLLC
Entity Type:Organization
Organization Name:LUDU SHARMA PROFESSIONAL SERVICES PLLC
Other - Org Name:DUPONT FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RHENU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-413-8505
Mailing Address - Street 1:PO BOX 1361
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-413-8505
Mailing Address - Fax:425-413-8144
Practice Address - Street 1:975 ROSS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327
Practice Address - Country:US
Practice Address - Phone:253-964-7000
Practice Address - Fax:253-964-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty