1891873758 NPI number — DR. JYOTI DESH SHARMA DMD

Table of content: DR. JYOTI DESH SHARMA DMD (NPI 1891873758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891873758 NPI number — DR. JYOTI DESH SHARMA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARMA
Provider First Name:
JYOTI
Provider Middle Name:
DESH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAHIYA
Provider Other First Name:
JYOTI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891873758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5140 BEECHAM CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024-3390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-433-1317
Provider Business Mailing Address Fax Number:
770-781-0204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 BUFORD RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30041-2731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-433-1317
Provider Business Practice Location Address Fax Number:
770-781-0204
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  DN012806 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 437813642M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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