1720395726 NPI number — ANUPAM D. SHARMA DDS PROFESSIONAL CORPORATION

Table of content: (NPI 1720395726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720395726 NPI number — ANUPAM D. SHARMA DDS PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANUPAM D. SHARMA DDS PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DENTAL COMFORT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720395726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 WALNUT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94538-1336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-490-4300
Provider Business Mailing Address Fax Number:
510-991-9949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 WALNUT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-1336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-490-4300
Provider Business Practice Location Address Fax Number:
510-991-9949
Provider Enumeration Date:
09/13/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHARMA
Authorized Official First Name:
ANUPAM
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
510-490-4300

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  47799 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)