Provider Demographics
NPI:1679728208
Name:PADMANABHAN, ANISHA SHARMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANISHA
Middle Name:SHARMA
Last Name:PADMANABHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 STALLION ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4973
Mailing Address - Country:US
Mailing Address - Phone:516-902-4941
Mailing Address - Fax:
Practice Address - Street 1:1026 E WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4914
Practice Address - Country:US
Practice Address - Phone:972-296-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0551311223P0221X
MADN18558401223P0221X
390200000X
TX287131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110091265AMedicaid
MA110076306AMedicaid
TX330454501Medicaid