Provider Demographics
NPI:1912569179
Name:SHARMA, VIBHUTI (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:VIBHUTI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:SIMRAN
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:11720 97TH LN NE APT A118
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8964
Mailing Address - Country:US
Mailing Address - Phone:404-433-3963
Mailing Address - Fax:
Practice Address - Street 1:19723 HIGHWAY 99 STE A
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6079
Practice Address - Country:US
Practice Address - Phone:425-651-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60956361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist