Provider Demographics
NPI:1083112072
Name:R NELSON SHARP DDS AND HARDY H FIELDS DDS MDS LLC
Entity Type:Organization
Organization Name:R NELSON SHARP DDS AND HARDY H FIELDS DDS MDS LLC
Other - Org Name:UNCOMMON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-625-1114
Mailing Address - Street 1:2330 S RANGE LINE RD STE E
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3267
Mailing Address - Country:US
Mailing Address - Phone:417-625-1114
Mailing Address - Fax:
Practice Address - Street 1:2330 S RANGE LINE RD STE E
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3267
Practice Address - Country:US
Practice Address - Phone:417-625-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty