Provider Demographics
NPI:1265567978
Name:SHARP, THOMAS D (DMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:SHARP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-5644
Mailing Address - Country:US
Mailing Address - Phone:256-236-5343
Mailing Address - Fax:256-236-5359
Practice Address - Street 1:100 E 7TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5644
Practice Address - Country:US
Practice Address - Phone:256-236-5343
Practice Address - Fax:256-236-5359
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL41261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL77791OtherBLUE CROSS PROVIDER #