Provider Demographics
NPI:1821511056
Name:SHARMA, BHAGWATI
Entity type:Individual
Prefix:DR
First Name:BHAGWATI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 WESLEYAN PL
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-3495
Mailing Address - Country:US
Mailing Address - Phone:678-823-0370
Mailing Address - Fax:
Practice Address - Street 1:1806 OVER LAKE DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1745
Practice Address - Country:US
Practice Address - Phone:770-760-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist