Provider Demographics
NPI:1174644132
Name:SHARPE, VIRGINIA LEE (DDS)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:SHARPE
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 1:6 CALLE MEDICO
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4761
Mailing Address - Country:US
Mailing Address - Phone:505-982-4686
Mailing Address - Fax:505-989-8266
Practice Address - Street 1:6 CALLE MEDICO
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4761
Practice Address - Country:US
Practice Address - Phone:505-982-4686
Practice Address - Fax:505-989-8266
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4228122300000X
MSDE2558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist