Provider Demographics
NPI:1760646368
Name:SANJEEV SHARMA P.S. DBA PREMIER DENTAL
Entity Type:Organization
Organization Name:SANJEEV SHARMA P.S. DBA PREMIER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS,MDS,MS
Authorized Official - Phone:360-882-9595
Mailing Address - Street 1:19221 SE 34TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8832
Mailing Address - Country:US
Mailing Address - Phone:360-882-9595
Mailing Address - Fax:360-882-3322
Practice Address - Street 1:19221 SE 34TH ST STE 106
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8832
Practice Address - Country:US
Practice Address - Phone:360-882-9595
Practice Address - Fax:360-882-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 83011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5043377Medicaid