Provider Demographics
NPI:1679589931
Name:SHARMA, DHIRAJ (DDS)
Entity type:Individual
Prefix:DR
First Name:DHIRAJ
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4949
Mailing Address - Country:US
Mailing Address - Phone:773-284-1645
Mailing Address - Fax:708-570-7567
Practice Address - Street 1:5342 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4949
Practice Address - Country:US
Practice Address - Phone:773-284-1645
Practice Address - Fax:708-570-7567
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004615Medicaid