Provider Demographics
NPI:1750834255
Name:ANDERSON, SHARITHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARITHA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHARITHA
Other - Middle Name:EBONI
Other - Last Name:HERRING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:117 PAVILION PKWY STE 15C
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7732
Mailing Address - Country:US
Mailing Address - Phone:770-953-6975
Mailing Address - Fax:
Practice Address - Street 1:117 PAVILION PKWY STE 15C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7732
Practice Address - Country:US
Practice Address - Phone:770-953-6975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist