Provider Demographics
NPI:1063239200
Name:ELSHARKASI, MARWA M O (BDS, MSD, ABOD)
Entity type:Individual
Prefix:DR
First Name:MARWA
Middle Name:M O
Last Name:ELSHARKASI
Suffix:
Gender:F
Credentials:BDS, MSD, ABOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 HOOSIER HILL DR APT 209
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3174
Mailing Address - Country:US
Mailing Address - Phone:317-985-7091
Mailing Address - Fax:
Practice Address - Street 1:1121 W MICHIGAN ST RM 112C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5211
Practice Address - Country:US
Practice Address - Phone:317-985-7091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INLDF240031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist