Provider Demographics
NPI:1114618642
Name:SHARMA, INDRA S (DDS)
Entity type:Individual
Prefix:DR
First Name:INDRA
Middle Name:S
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 1:6319 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2888
Mailing Address - Country:US
Mailing Address - Phone:888-736-6430
Mailing Address - Fax:
Practice Address - Street 1:6319 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2888
Practice Address - Country:US
Practice Address - Phone:888-736-6430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist