Provider Demographics
NPI:1134212103
Name:SHARMA, RAJESH (DDS)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 EASTERLING DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4817
Mailing Address - Country:US
Mailing Address - Phone:407-870-5004
Mailing Address - Fax:407-870-8366
Practice Address - Street 1:809 E OAK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5834
Practice Address - Country:US
Practice Address - Phone:407-870-5004
Practice Address - Fax:407-870-8366
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN106321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL077825700Medicaid