Provider Demographics
NPI:1891128245
Name:SHARMA, MANU (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANU
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11145 CAMINO RUIZ
Mailing Address - Street 2:APT:34
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1763
Mailing Address - Country:US
Mailing Address - Phone:619-456-7504
Mailing Address - Fax:
Practice Address - Street 1:11145 CAMINO RUIZ
Practice Address - Street 2:APT:34
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-1763
Practice Address - Country:US
Practice Address - Phone:619-456-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist