Provider Demographics
NPI:1528733326
Name:SHARMA CHANDLER, PRATIMA (DDS)
Entity type:Individual
Prefix:
First Name:PRATIMA
Middle Name:
Last Name:SHARMA CHANDLER
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 1:37 MADDEX DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-4322
Mailing Address - Country:US
Mailing Address - Phone:304-876-2562
Mailing Address - Fax:
Practice Address - Street 1:37 MADDEX DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-4322
Practice Address - Country:US
Practice Address - Phone:304-876-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46131223G0001X
VA0401417611122300000X
MD178161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist