Provider Demographics
NPI:1851518153
Name:WEST SIDE DENTAL
Entity Type:Organization
Organization Name:WEST SIDE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MDS, MS
Authorized Official - Phone:360-574-8181
Mailing Address - Street 1:10009 NE HAZEL DELL AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-5203
Mailing Address - Country:US
Mailing Address - Phone:360-574-8181
Mailing Address - Fax:360-574-8188
Practice Address - Street 1:10009 NE HAZEL DELL AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-5203
Practice Address - Country:US
Practice Address - Phone:360-574-8181
Practice Address - Fax:360-574-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA83011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty