Provider Demographics
NPI:1730719253
Name:LAWRENCEVILLE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:LAWRENCEVILLE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:404-786-7616
Mailing Address - Street 1:4850 SUGARLOAF PKWY STE 611
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2866
Mailing Address - Country:US
Mailing Address - Phone:678-629-3663
Mailing Address - Fax:
Practice Address - Street 1:4850 SUGARLOAF PKWY STE 611
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2866
Practice Address - Country:US
Practice Address - Phone:678-629-3663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental