Provider Demographics
NPI:1629436902
Name:SHARMA, SANJEEV K (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:K
Last Name:SHARMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MERRITT BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-2140
Mailing Address - Country:US
Mailing Address - Phone:609-216-1865
Mailing Address - Fax:
Practice Address - Street 1:1401 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-2140
Practice Address - Country:US
Practice Address - Phone:609-216-1865
Practice Address - Fax:609-216-1865
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD16575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program