# SHARLETTE NICOLE VICTORINO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1558567396
- **Gender:** F
- **Credential:** DMD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 014483 | GA | — |
| 1223G0001X | General Practice Dentistry | 12012074A | IN | Yes |
| 1223G0001X | General Practice Dentistry | 8589 | KY | — |
| 1223G0001X | General Practice Dentistry | 8665 | TN | — |

## Other

- **Enumeration date:** 06/26/2007
- **Last updated:** 01/22/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1223G0001X | EPSDT | KY |
| 05 | — | 1223G0001X | — | KY |