Provider Demographics
NPI:1891873758
Name:SHARMA, JYOTI DESH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:DESH
Last Name:SHARMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JYOTI
Other - Middle Name:
Other - Last Name:DAHIYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5140 BEECHAM CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3390
Mailing Address - Country:US
Mailing Address - Phone:404-433-1317
Mailing Address - Fax:770-781-0204
Practice Address - Street 1:1240 BUFORD RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-2731
Practice Address - Country:US
Practice Address - Phone:404-433-1317
Practice Address - Fax:770-781-0204
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA437813642MMedicaid