Provider Demographics
NPI:1073249983
Name:JACOB, SHARON ANITHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANITHA
Last Name:JACOB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 NW 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-6821
Mailing Address - Country:US
Mailing Address - Phone:786-384-9174
Mailing Address - Fax:
Practice Address - Street 1:1909 NW 80TH AVE
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-6821
Practice Address - Country:US
Practice Address - Phone:786-384-9174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist