Provider Demographics
NPI:1700934874
Name:SHARMA, ANEET K (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:ANEET
Middle Name:K
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4185
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-4185
Mailing Address - Country:US
Mailing Address - Phone:479-717-1056
Mailing Address - Fax:479-725-2395
Practice Address - Street 1:2926 W HUNTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-7726
Practice Address - Country:US
Practice Address - Phone:479-927-3030
Practice Address - Fax:479-927-3085
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE29631223S0112X, 204E00000X
AR33531223S0112X, 204E00000X
MO20020024521223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W678OtherBCBS
AR234282400OtherDEPT OF LABOR WORKERS COM
AR1446671679Medicaid