Provider Demographics
NPI:1710259346
Name:SHARMA, SUHASINI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUHASINI
Middle Name:
Last Name:SHARMA
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 1:3001 BONITA RD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3224
Mailing Address - Country:US
Mailing Address - Phone:619-474-1554
Mailing Address - Fax:619-474-1584
Practice Address - Street 1:3001 BONITA RD
Practice Address - Street 2:SUITE #400
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3224
Practice Address - Country:US
Practice Address - Phone:619-474-1554
Practice Address - Fax:619-474-1584
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52468122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist