Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 57799 | CA |
NPI | 1003069667 |
---|---|
Provider Name | Dr. Sandeep Sharma |
First Address | Santa Ana, CA 92707-5645 |
Second Address | Santa Ana, CA 92707-5645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 28/10/2008 |