Basic Information
Provider Information
NPI: 1861730343
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHARMA
FirstName: NIVEDITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2409 SE DELAWARE AVENUE STE 100
Address2:  
City: ANKENY
State: IA
PostalCode: 50021
CountryCode: US
TelephoneNumber: 5159634343
FaxNumber:  
Practice Location
Address1: 4920 SOUTH 30TH STREET
Address2: SUITE 103
City: OMAHA
State: NE
PostalCode: 681071656
CountryCode: US
TelephoneNumber: 4029327204
FaxNumber: 4029521020
Other Information
ProviderEnumerationDate: 01/17/2013
LastUpdateDate: 08/05/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X7194NEY Dental ProvidersDentist 

No ID Information.


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