Provider Demographics
NPI:1063544856
Name:SHARMA, VINOD K
Entity type:Individual
Prefix:DR
First Name:VINOD
Middle Name:K
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 UNIVERSITY AVE.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-0453
Mailing Address - Country:US
Mailing Address - Phone:718-294-0700
Mailing Address - Fax:
Practice Address - Street 1:1715 UNIVERSITY AVE.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-0453
Practice Address - Country:US
Practice Address - Phone:718-294-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0354911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice