Provider Demographics
NPI:1447950696
Name:SHRESTHA, SHARON (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:SHRESTHA
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 1:3654 CROWBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-7176
Mailing Address - Country:US
Mailing Address - Phone:214-463-4736
Mailing Address - Fax:
Practice Address - Street 1:5800 N TARRANT PKWY STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8003
Practice Address - Country:US
Practice Address - Phone:817-581-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist