Provider Demographics
NPI:1275775439
Name:RUSSELL, SHARON SHERISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:SHERISE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3305 OLD LARGO RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7811
Mailing Address - Country:US
Mailing Address - Phone:301-780-8363
Mailing Address - Fax:
Practice Address - Street 1:9632 MARLBORO PIKE UPPR MARLBORO
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3767
Practice Address - Country:US
Practice Address - Phone:301-967-0183
Practice Address - Fax:301-576-5800
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery