Provider Demographics
NPI:1326007246
Name:BADER, SHARON (DDS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BADER
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 1:9059 W LAKE PLEASANT PKWY
Mailing Address - Street 2:F 600
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8336
Mailing Address - Country:US
Mailing Address - Phone:623-825-5595
Mailing Address - Fax:623-825-5129
Practice Address - Street 1:9059 W LAKE PLEASANT PKWY
Practice Address - Street 2:F 600
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8336
Practice Address - Country:US
Practice Address - Phone:623-825-5595
Practice Address - Fax:623-825-5129
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ704701Medicaid