Provider Demographics
NPI:1194053397
Name:THAKKAR, DIPA SHARMA (DDS)
Entity type:Individual
Prefix:DR
First Name:DIPA
Middle Name:SHARMA
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4078 SWEAT CREEK CV
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1180
Mailing Address - Country:US
Mailing Address - Phone:517-902-1797
Mailing Address - Fax:
Practice Address - Street 1:3329 COBB PKWY NW STE 300
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8841
Practice Address - Country:US
Practice Address - Phone:678-809-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028160122300000X
GADN1222241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019.028160Medicaid